Predicting Severe Hypoglycemia among Older Adults with Diabetes

预测老年糖尿病患者的严重低血糖

• 批准号: 8769659
• 负责人: Kasia Joanna Lipska
• 金额: $ 15.68万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8769659
• 关键词: Accident and Emergency department; Acute; Address; Admission activity; Adult; Adverse effects; Advocate; Aging; American; Award; Biostatistical Methods; Blindness; Blood Glucose; Cardiovascular system; Caring; Clinical; Clinical Trials; Complication; Computerized Medical Record; Data; Data Set; Databases; Decision Making; Development; Diabetes Mellitus; Elderly; End stage renal failure; Endocrinologist; Endocrinology; Equilibrium; European; Evaluation; Event; Face; Fostering; Future; Geriatrics; Gills; Glucose; Glycosylated hemoglobin A; Goals; Health; Healthcare; Healthcare Industry; Hospitalization; Hospitals; Hypoglycemia; Incidence; Individual; Insulin; Interdisciplinary Study; Interview; Investigation; Knowledge; Lead; Learning; Life; Measures; Mentors; Methods; Modeling; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Outcomes Research; Patient Care; Patients; Perception; Persons; Pharmaceutical Preparations; Pharmacotherapy; Pilot Projects; Policies; Population; Probability; Qualitative Methods; Quality of Care; Reaction; Renal dialysis; Research; Research Methodology; Research Personnel; Risk; Risk Factors; Science; Societies; System; Testing; Time; Training; United States Centers for Medicare and Medicaid Services; Universities; Visit; Work; age related; aged; blood glucose regulation; career; clinical care; clinical practice; clinical risk; comparative effectiveness; diabetes management; experience; forging; functional decline; functional disability; glycemic control; implementation science; improved; innovation; medical schools; mortality; older patient; patient oriented; programs; public health relevance; repository; skills; success; tool; treatment strategy

DESCRIPTION (provided by applicant): More than ten million older Americans have diabetes and nearly all take medications to lower glucose levels. As a result of this treatment, many of these patients experience severe hypoglycemia, which is associated with poor outcomes including mortality. In order to improve the quality of diabetes care, we need to optimize treatment strategies and reduce these preventable complications. Yet, little information exists to help characterize a patient's risk for severe hypoglycemia. Clinicians and patients are essentially operating in the dark-without reliable evidence-when making important decisions about treatments with potentially life- threatening consequences. My goal is to generate that evidence and help older patients understand the risks they face so they can make more informed decisions about the trade-offs in treatment and, ultimately, achieve the outcomes that matter most to them. My hypothesis is that a simple clinical risk score can help identify which individuals are at greatest risk for severe hypoglycemia. Furthermore, this risk score can be incorporated into an electronic medical record system to improve treatment decisions and optimize diabetes management. My research has 3 specific aims: 1) estimate the annual incidence of severe hypoglycemia among older adults with type 2 diabetes (overall and by type of therapy); 2) develop and validate a clinical risk score for severe hypoglycemia; and 3) conduct a pilot study to assess the feasibility of using the risk score during clinical encounters and to assess its impact on treatment decisions. My career goals are to become an independent investigator and a national leader with expertise in outcomes research focusing on older adults who have diabetes. I am an endocrinologist with a track record of early success, including a GEMSSTAR R03 award. I have an exceptional team of mentors who are national leaders in outcomes research (Dr. Harlan Krumholz), geriatrics (Dr. Thomas Gill), and diabetes (Dr. Silvio Inzucchi). With their guidance, I have assembled an ideal set of data assets to address my aims. During the award period, I will gain skills in biostatistical methods, primary data collectio, and mixed methods research, and use implementation science methods to learn how to best bring my findings into clinical care. As part of my training, I will also lead the development of diabetes quality of care measures for the Centers of Medicare and Medicaid Services. The work proposed in my Beeson application is innovative because I intend to shift the paradigm of diabetes management among older individuals - from an intense focus on glucose control to a more balanced examination of patient-important outcomes, including adverse effects of therapies. I plan to forge strategic partnerships between leaders in aging research, outcomes research, and Optum Labs - which has an untapped database of extraordinary size and scope. This team can redefine the treatment of older patients with type 2 diabetes, by providing information that is currently nonexistent and yet critically needed.

描述（由申请人提供）：超过一千万的美国人患有糖尿病，几乎所有药物都可以降低葡萄糖水平。由于这种治疗方法，其中许多患者患有严重的低血糖，这与包括死亡率在内的不良结局有关。为了提高糖尿病护理的质量，我们需要优化治疗策略并减少这些可预防的并发症。然而，很少有信息可以帮助患者患严重低血糖症的风险。临床医生和患者基本上是在黑暗没有可靠的证据中运作的 - 在对可能威胁生命的后果的治疗做出重要决定时。我的目标是产生证据并帮助老年患者了解他们面临的风险，以便他们可以对治疗方面的权衡做出更明智的决定，并最终取得对他们最重要的结果。我的假设是，简单的临床风险评分可以帮助确定哪些人患严重低血糖症的风险最大。此外，该风险评分可以纳入电子病历系统，以改善治疗决策并优化糖尿病管理。我的研究具有3个具体目的：1）估计2型糖尿病老年人（总体和按治疗类型）中严重低血糖症的年发病率； 2）发展并验证严重低血糖症的临床风险评分； 3）进行一项试点研究，以评估在临床相遇期间使用风险评分并评估其对治疗决策的影响的可行性。我的职业目标是成为一名独立的研究者和国家领导者，在重点是患有糖尿病的老年人的结果研究方面具有专业知识。我是一名内分泌学家，具有早期成功的记录，其中包括Gemsstar R03奖。我有一个杰出的导师团队，他们是成果研究的国家领导者（Harlan Krumholz博士），老年医学（Thomas Gill博士）和糖尿病（Silvio Inzucchi博士）。在他们的指导下，我组装了一组理想的数据资产来解决我的目标。在奖励期间，我将获得生物统计学方法，主要数据收集和混合方法研究的技能，并使用实施科学方法来学习如何最好地将我的发现带入临床护理。作为我培训的一部分，我还将领导医疗保险和医疗补助服务中心的糖尿病质量护理质量措施的发展。我的比森应用程序中提出的工作具有创新性，因为我打算将糖尿病管理的范式转移到老年人之间 - 从对葡萄糖控制的强烈关注到对患者至关重要的结果的更加平衡的检查，包括对治疗的不良反应。我计划在老龄化研究，成果研究和Optum Labs中建立战略合作伙伴关系，该伙伴具有非凡规模和范围的未开发数据库。该团队可以通过提供目前不存在但急需的信息来重新定义2型糖尿病患者的治疗。