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

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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.