Race/ethnic Differences Among Older Patients with Type 2 Diabetes at Risk for Hypoglycemia

项目摘要 许多患有2型糖尿病（T2D）的老年人由于密集的T2D而经历危险的低血糖 药物治疗降低治疗强度的决定必须根据患者的偏好， 价值观新的工具，教育病人，建立他们的沟通技巧，以表达他们的喜好提供了一个 提高高危老年人T2D护理安全性的有前途的策略。该R01奖项的目标是 将价值观启发和技能建设的原则应用于具体的沟通和决策， 低血糖相关的不良后果在脆弱的老年患者的临床问题。的目标 父母R01将开发一种在线工具，专门解决老年人的T2D治疗强度， 增加低血糖事件的风险，然后进行随机试验，以评估这种治疗的疗效。 减少≥ 75岁高风险患者低血糖事件的新工具。我们的支持方式 价值取向的护理是一种创新的和潜在的广泛适用的方法，以帮助老年人 根据他们的目标和偏好做出明智的决定。如果成功，这个框架可以扩展到 并应用于各种各样的医疗保健环境和慢性疾病，其中不断变化的风险，益处， 治疗的结果需要随着年龄的增长而重新评估。Dana Abdelgadir的加入 这份行政补充文件将为该项目提供一个极好的机会， 对我们临床试验中的非裔美国人参与者的分析（约12%的预期参与者， 与北方加州的源人口比例相似）， 研究老年非裔美国糖尿病患者如何参与 与医疗保健系统和目前的药物相关的做法。进一步的研究集中在老年人 我们试验中的非洲裔美国人有可能为如何最好地吸引这名患者提供有用的见解 研究旨在提高参与度和降低药物风险。拟议研究 直接关系到家长补助金的主要目标，同时也扩大了我们的项目，通过扩大我们的 对非裔美国患者的比较分析。这项研究涉及NIH的三个优先事项， 将证据转化为实践，提高用药安全性，了解医疗保健差异。的 在代表不足的少数民族（URM）行政补充中提出的具体项目将侧重于 对患有2型糖尿病的老年非裔美国人进行了更详细的检查， 低血糖这项补充工作将进一步深入了解潜在的差异和独特的 在初级保健访问期间，老年非裔美国人面临的沟通障碍。

Project Summary Many older adults with type 2 diabetes (T2D) experience dangerous hypoglycemic due to intensive T2D medication treatment. The decision to reduce treatment intensity must be informed by patient preferences and values. 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.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. 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 Dana Abdelgadir through this Administrative Supplement will provide the project with the excellent opportunity to conduct more detailed analyses of African American participants in our clinical trial (approximately 12% of expected participants, similar proportion to the source population in Northern California) by allowing an increased emphasis on examining the similarities and unique differences in how older African American patients with diabetes engage with the health care system and to current medication-related practices. Further study focused on older African Americans in our trial 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. 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 African American 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 a more detailed examination of older African American 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 African Americans during primary care visits.