Differences Among Older English and Spanish-speaking Latinx Patients with Type 2 Diabetes at Risk for Hypoglycemia (Admin Supp)

患有低血糖风险的老年英语和西班牙语拉丁裔 2 型糖尿病患者之间的差异（管理补充）

• 批准号: 10598945
• 负责人: RICHARD W GRANT
• 金额: $ 8.14万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-15 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10598945
• 关键词: Address; Administrative Supplement; Adult; Age; Age-Years; Award; Benefits and Risks; California; Caring; Chronic; Clinical; Clinical Trials; Communication; Dangerousness; Decision Making; Diabetes Mellitus; Elderly; Ethnic Origin; Event; Goals; Healthcare Systems; Hispanic; Hypoglycemia; Latinx; Methods; Non-Insulin-Dependent Diabetes Mellitus; Parents; Participant; Patient Preferences; Patients; Pharmaceutical Preparations; Population; Primary Health Care; Provider; Race; Research; Research Design; Risk; Safety; Source; Translating; Underrepresented Minority; United States National Institutes of Health; Visit; Voice; Work; adverse outcome; base; comparative; experience; health care disparity; health care settings; high risk; improved; innovation; insight; medication safety; older patient; parent grant; patient population; preference; randomized trial; skills; tool

Project Summary Many older adults with type 2 diabetes (T2D) experience dangerous hypoglycemic due to intensive T2D medication treatment.1,2 The decision to reduce treatment intensity must be informed by patient preferences and values.3 New tools that educate patients and build their communication skills to voice their preferences offer a promising strategy for improving the safety of T2D care in high-risk older adults.4,5 The goal of this R01 award is to apply principles of values elicitation and skill building for communication and decision making to the specific clinical problem of hypoglycemia-related adverse outcomes in vulnerable older patients. The aims of the parent R01 are to develop an online tool to specifically address T2D treatment intensity in older adults at increased risk for hypoglycemic events, and to then conduct a randomized trial to assess the efficacy of this new tool to reduce hypoglycemia events among high-risk patients 75 years of age. Our approach to support value-aligned care represents an innovative and potentially widely applicable method to help older adults to make informed decisions based on their goals and preferences.6 If successful, this framework could be scaled and applied in a wide variety of healthcare settings and chronic conditions in which evolving risks, benefits, and consequences of treatment require re-assessment with age. The addition of Clarissa Ferguson through this Administrative Supplement will provide the project with the excellent opportunity to conduct analyses of older Hispanic/Latinx participants who would otherwise be eligible for our clinical trial (approximately 29% of expected participants, similar proportion to the source population in Northern California).7 She will examine the similarities and unique differences in how older Hispanic/Latinx patients with type 2 diabetes versus adults from other race/ethnicities engage with the health care system and their current medication-related practices. Further study focused on older Hispanic/Latinx patients has the potential to provide useful insight into how to best engage this patient population in research designed to improve engagement and reduce medication risk.8 The proposed research is directly related to the main goals of the parent grant while also broadening our project by extending our comparative analyses of Hispanic/Latinx patients. This study addresses the three NIH priorities of translating evidence into practice, improving medication safety, and understanding health care disparities. The specific project proposed within the Under-Represented Minority (URM) Administrative Supplement will focus on the examination of older Hispanic/Latinx patients with type 2 diabetes at increased risk for hypoglycemia. This supplemental work will provide further insight into the potential disparities and unique barriers to communication faced by older Hispanic/Latinx patients during primary care visits.

项目概要 许多患有 2 型糖尿病 (T2D) 的老年人因强化 T2D 而经历危险的低血糖 药物治疗。1,2 降低治疗强度的决定必须根据患者的喜好 3 教育患者并培养他们表达偏好的沟通技巧的新工具 为提高高危老年人 T2D 护理的安全性提供了一个有前景的策略。4,5 本 R01 的目标 奖项旨在将价值观启发和技能培养的原则应用于沟通和决策 弱势老年患者低血糖相关不良后果的具体临床问题。的目标 家长 R01 将开发一个在线工具，专门解决老年人 T2D 治疗强度问题 增加低血糖事件的风险，然后进行随机试验来评估其疗效 减少 75 岁高危患者低血糖事件的新工具。我们的支持方法 价值一致的护理代表了一种创新且可能广泛适用的方法，可以帮助老年人 根据他们的目标和偏好做出明智的决定。6 如果成功，该框架可以扩展 并应用于各种医疗保健环境和慢性病，其中不断变化的风险、益处和 治疗的后果需要随着年龄的增长而重新评估。克拉丽莎·弗格森的加入 行政补充将为该项目提供绝佳的机会来对较旧的数据进行分析 原本有资格参加我们的临床试验的西班牙裔/拉丁裔参与者（约 29% 预期的参与者，与北加州的源人口比例相似）。7 她将检查 西班牙裔/拉丁裔老年 2 型糖尿病患者与成人的相似点和独特差异 来自其他种族/民族的人参与医疗保健系统及其当前的药物相关实践。 针对老年西班牙裔/拉丁裔患者的进一步研究有可能为如何 最好让这些患者群体参与旨在提高参与度和降低用药风险的研究。8 拟议的研究与家长资助的主要目标直接相关，同时也拓宽了我们的研究范围 项目通过扩展我们对西班牙裔/拉丁裔患者的比较分析。这项研究涉及 NIH 的三个 将证据转化为实践、提高用药安全性和了解医疗保健的优先事项 差异。代表性不足的少数群体 (URM) 行政部门内提出的具体项目 增补将重点关注老年西班牙裔/拉丁裔 2 型糖尿病患者的检查，增加 低血糖的风险。这项补充工作将进一步深入了解潜在的差异和 老年西班牙裔/拉丁裔患者在初级保健就诊期间面临独特的沟通障碍。