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

低血糖和高血糖对患有糖尿病、阿尔茨海默病和相关痴呆 (ADRD) 的新罕布什尔州居民老年不良结局的影响

• 批准号: 10477334
• 负责人: Alexandra Kathryn Lee
• 金额: $ 13.2万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10477334
• 关键词: Acute; Address; Adult; Affect; Aging; Alzheimer' s disease related dementia; Attention; Behavior; Blood Glucose; Caregivers; Caring; Clinical; Cognition; Complex; Crossover Design; Data; Data Set; Databases; Dementia; Diabetes Mellitus; Doctor of Philosophy; Elderly; Electronic Health Record; Environment; Epidemiologist; Epidemiology; Expert Opinion; Foundations; Frail Elderly; Funding; Geriatric Assessment; Geriatrics; Glucose; Goals; Guidelines; Health; Health Services; Hyperglycemia; Hypoglycemia; Impaired cognition; Incidence; Incontinence; Insulin; Link; Measurement; Measures; Medical; Mentored Research Scientist Development Award; Mentors; Mentorship; Methodology; Methods; Neurology; Non-Insulin-Dependent Diabetes Mellitus; Nursing Homes; Outcome; Policies; Population; Psychiatry; Quality of Care; Quality of life; Recommendation; Research; Research Design; Research Personnel; Risk; Severities; Source; Structural Models; Symptoms; Syndrome; System; Testing; Time; Training; United States Department of Veterans Affairs; Universities; Urinary tract infection; Vulnerable Populations; base; career; career development; clinical care; cognitive function; comorbidity; diabetes management; evidence base; experience; falls; functional decline; high risk; human old age (65+); improved; mid-career faculty; multiple chronic conditions; professor; skills

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.

项目总结/文摘