Improving Care for Nursing Home residents with Diabetes and Cognitive Impairment

公共卫生意义：患有糖尿病和阿尔茨海默病以及相关痴呆的疗养院(NH)居民是一个庞大的、不断增长的人群，具有不良后果的高风险。不幸的是，人们对目前的临床护理做法或这些护理做法对患有糖尿病和阿尔茨海默病以及相关痴呆症的NH居民的结果知之甚少。这项拟议的研究将检查患有糖尿病的NH居民的临床实践和结果，涉及阿尔茨海默病和相关痴呆的严重程度。 研究目标：拟议的项目将比较阿尔茨海默病和相关痴呆严重程度的指纹状血糖测量率(目标1)，比较轻度低血糖(定义为美国糖尿病协会或ADA级别1：葡萄糖70-54 mg/dL)和中度低血糖(ADA级别2：葡萄糖54 mg/dL)的比率(目标2)，并确定可能的血糖过度治疗的比率(定义为联合使用胰岛素和血红蛋白A1c或HbA1c&lt；长期入住疗养院居民的阿尔茨海默病和相关痴呆的严重程度(目标3)中，可能存在血糖过低(定义为不使用药物或仅对糖化血红蛋白9.0%的患者使用二甲双胍)。 候选人的职业发展和指导计划：候选人提议扩大他的成功导师计划，聘请更多的导师来帮助完成拟议的项目。候选人将继续发展为一名研究人员，通过扩展他在NH研究方面的技能，专注于大量患有阿尔茨海默病和相关痴呆的NH居民。候选人将继续发展成为一名导师，通过培养领导技能和专注于支持来自弱势背景的受训者。 候选人的职业目标：候选人的长期目标是成为全国老龄化研究的领先者，专注于患有阿尔茨海默病和相关痴呆症的NH居民，同时成为老龄化研究的卓越导师。

Public Health Significance: Nursing home (NH) residents with diabetes and Alzheimer’s disease and related dementias are a large, growing population at high risk for adverse outcomes. Unfortunately, little is known about current clinical care practices or the outcomes that result from those care practices in NH residents with diabetes and Alzheimer’s disease and related dementias. The proposed studies will examine those clinical practices and outcomes in NH residents with diabetes across the spectrum of severity of Alzheimer’s disease and related dementias. Research Aims: The proposed projects will compare the rates of fingerstick glucose measurement across the spectrum of severity of Alzheimer’s disease and related dementias (Aim 1), compare the rates of mild hypoglycemia (defined as American Diabetes Association or ADA level 1: glucose 70-54 mg/dL) and moderate hypoglycemia (ADA level 2: glucose <54 mg/dL) across the spectrum of severity of Alzheimer’s disease and related dementias (Aim 2) and determine the rates of likely glycemic overtreatment (defined as use of insulin with hemoglobin A1c or HbA1c <7.5%) and likely glycemic undertreatment (defined as use of no medications or metformin only with HbA1c >9.0%) across the spectrum of severity of Alzheimer’s disease and related dementias in long-stay nursing home residents (Aim 3). Candidate’s Career Development and Mentoring Plan: The candidate proposes to expand his successful mentorship program, taking on additional mentees to help complete the proposed projects. The candidate will continue to develop as a researcher by expanding his skills in NH research focusing on the large number of NH residents with Alzheimer’s disease and related dementias. The candidate will continue to develop as a mentor by building leadership skills and focusing on supporting mentees from disadvantaged backgrounds. Candidate’s Career Goals: Candidate’s long-term goals are to become a national leader in aging research focusing on NH residents with Alzheimer’s disease and related dementias, while becoming a pre-eminent mentor in aging research.