Contributions of Hypoglycemia and Hyperglycemia to Adverse Geriatric Outcomes in NH Residents with Diabetes and Alzheimer's Disease and Related Dementias (ADRD)

项目总结/摘要 疗养院（NH）居民与2型糖尿病有大量的多发病，使糖尿病并发症 管理阿尔茨海默病和相关痴呆症影响近50%的NH居民， 增加低血糖风险。目前的NH糖尿病管理指南不涉及阿尔茨海默氏症 疾病和相关痴呆以及目前对NH目标血糖范围的建议是基于 根据专家的意见，而不是在某些临界值的不利老年结果的证据。到 针对这些弱点，我们提出了以下目标：1）比较低血糖和高血糖的发生率， 2）检查低血糖和高血糖对痴呆状态的急性影响， 老年综合征，并评估阿尔茨海默病和相关痴呆是否改变血糖 阈值，和3）检查低和高血压对认知能力下降的累积影响， 功能下降，并确定是否基线阿尔茨海默病和相关痴呆症的严重程度 改变血糖阈值。拟议的研究利用现有的退伍军人事务部电子健康 记录数据库，常规手指针刺血糖测量的唯一来源。长期目标是 研究是建立具有低血糖阈值的NH特异性目标血糖范围， 高血糖症是导致阿尔茨海默病和相关痴呆症的原因。李博士寻求 K 01指导研究科学家发展奖，以获得基本技能和指导研究 经验，这将启动她的职业生涯作为一个独立的研究人员在老龄化领域，糖尿病， 阿尔茨海默氏病和相关痴呆症。五年培训计划将填补老年医学内容空白 综合征和阿尔茨海默病和相关痴呆症的评估，同时建立在她的 方法优势包括先进的因果推理方法和使用电子健康记录 用于研究李博士将在UCSF分部丰富的培训环境中完成拟议的研究 老年医学，与老年医学卫生服务研究员李世石博士，医学博士，MAS， 加州大学旧金山分校老年医学教授，痴呆症专家Kristine Yaffe博士共同指导，医学博士， 精神病学，神经病学和流行病学在加州大学旧金山分校，和老龄流行病学博士米歇尔奥登，博士， 斯坦福大学卫生研究与政策系流行病学副教授。与 在她的导师、合作导师和受人尊敬的顾问的支持下，李博士将朝着成功的方向前进。 竞争R 01基金，成为老年糖尿病领域的领导者。

Project Summary/Abstract Nursing home (NH) residents with type 2 diabetes have substantial multimorbidity that complicates diabetes management. Alzheimer's Disease and related dementias affects nearly 50% of NH residents and may increase risk of hypoglycemia. Current NH diabetes management guidelines do not address Alzheimer's Disease and related dementias and current recommendations for NH target blood glucose ranges are based on expert opinion rather than evidence of adverse geriatric outcomes at certain thresholds of glycemia. To address these weaknesses, we propose the following aims: 1) to compare the incidence rates of hypo- and hyper-glycemia in the NH by dementia status, 2) to examine the acute effects of hypo- and hyper-glycemia on geriatric syndromes and evaluate whether Alzheimer's Disease and related dementias modifies glycemic thresholds, and 3) to examine the cumulative effects of hypo- and hyper-glycemia on cognitive decline and functional decline, and to determine whether baseline severity of Alzheimer's Disease and related dementias modifies glycemic thresholds. The proposed research leverages existing Veterans Affairs electronic health record databases, a unique source of routine fingerstick glucose measurements. The long-term goal of this research is to establish NH-specific target blood glucose ranges with thresholds of hypoglycemia and hyperglycemia that account for the presence of Alzheimer's Disease and related dementias. Dr. Lee seeks a K01 Mentored Research Scientist Development Award to obtain essential skills and mentored research experience that will launch her career as an independent investigator in the field of aging, diabetes, and Alzheimer's Disease and related dementias. The five-year training plan will fill content gaps in geriatric syndromes and the assessment of Alzheimer's Disease and related dementias while building on her methodological strengths to include advanced causal inference methods and using electronic health records for research. Dr. Lee will complete the proposed research in the rich training environment of the UCSF Division of Geriatrics, with primary mentorship from geriatrics health services researcher Dr. Sei Lee, MD, MAS, Professor of Geriatrics at UCSF, co-mentorship by dementia expert Dr. Kristine Yaffe, MD, Professor of Psychiatry, Neurology and Epidemiology at UCSF, and aging epidemiologist Dr. Michelle Odden, PhD, Associate Professor of Epidemiology in the Division of Health Research and Policy at Stanford University. With the support of her mentors, co-mentors, and esteemed advisors, Dr. Lee will advance towards successfully competing for R01 funding and becoming a leader in geriatric diabetes.