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.

项目概要/摘要 患有 2 型糖尿病的疗养院 (NH) 居民患有多种疾病，导致糖尿病复杂化 管理。阿尔茨海默病和相关痴呆症影响着新罕布什尔州近 50% 的居民，并且可能 增加低血糖的风险。目前的 NH 糖尿病管理指南并未针对阿尔茨海默病 疾病和相关痴呆症以及当前 NH 目标血糖范围的建议基于 基于专家意见，而不是在某些血糖阈值下不良老年结局的证据。到 为了解决这些弱点，我们提出以下目标：1）比较低血压和低血压的发生率 NH 中的高血糖（按痴呆状态），2) 检查低血糖和高血糖对 老年综合症并评估阿尔茨海默氏病和相关痴呆症是否会改变血糖 阈值，3) 检查低血糖和高血糖对认知能力下降的累积影响 功能衰退，并确定阿尔茨海默病和相关痴呆症的基线严重程度 改变血糖阈值。拟议的研究利用现有退伍军人事务部电子健康 记录数据库，常规指尖血糖测量的独特来源。本次活动的长远目标 研究的目的是建立 NH 特定的目标血糖范围以及低血糖阈值和 高血糖是导致阿尔茨海默病和相关痴呆症的原因。李博士寻求 K01 指导研究科学家发展奖，以获得基本技能和指导研究 这段经历将开启她作为衰老、糖尿病和糖尿病领域的独立研究者的职业生涯。 阿尔茨海默病和相关痴呆症。五年培训计划将填补老年医学领域的内容空白 综合症以及阿尔茨海默病和相关痴呆症的评估，同时以她为基础 方法论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。 Lee博士将在UCSF分部丰富的培训环境中完成拟议的研究 老年病学部，主要由老年病学健康服务研究员 Sei Lee 博士（医学博士、MAS）指导， 加州大学旧金山分校老年病学教授，由痴呆症专家 Kristine Yaffe 博士（医学博士、教授）共同指导 加州大学旧金山分校精神病学、神经病学和流行病学以及老龄流行病学家 Michelle Odden 博士 斯坦福大学健康研究与政策部流行病学副教授。和 在导师、共同导师和尊敬的顾问的支持下，李博士将迈向成功 竞争 R01 资金并成为老年糖尿病领域的领导者。