Type 2 Diabetes Risk in Women With Gestational Diabetes

描述(由申请人提供)： 候选人：这位候选人在哥伦比亚大学获得医学博士和公共卫生硕士学位，在加州大学旧金山分校担任内科住院医师，并完成了罗伯特·伍德·约翰逊临床学者的医疗服务研究奖学金。她目前在妇产科从事妇女保健工作，她对改善糖耐量异常妇女的护理质量的研究事业感兴趣。赞助商和环境：威廉·赫尔曼，医学博士，医学博士，密歇根州糖尿病研究和培训主任，糖尿病专家，在糖尿病流行病学和健康服务领域培训了许多研究人员。赫尔曼博士是糖尿病研究转化为行动(TRIAD)研究的PI，该研究检查糖尿病护理的质量。他非常熟悉这个项目中提出的研究方法，并将监督金博士的正规教育。研究：这项建议的长期目标是提高对糖耐量异常妇女的护理质量，特别是妊娠期糖尿病(GDM)或在怀孕期间首次发现的葡萄糖耐量异常的妇女。20%患有妊娠期糖尿病的妇女在分娩后5年内发展为2型糖尿病(DM)。尚不清楚适度的预防策略对妊娠期糖尿病妇女预防糖尿病是否有效。首先，金博士将检查有妊娠期糖尿病病史的女性目前的护理质量。具体地说，她将研究为糖尿病预防提供的咨询，以及可用于糖尿病预防的资源，以及与患者和医生特征的相关性。这项研究将采用横断面设计，包括有妊娠期糖尿病病史的妇女(n=400)。信息将主要从患者和医生的调查中获得。这项研究将利用三合会研究的基础设施进行主体识别、数据收集和分析。然后，候选人将进行一项试点研究，将患有妊娠期糖尿病的妇女随机分为常规护理和干预(团体或电话支持)(n=100)。我们将使现有的干预措施适用于妊娠期糖尿病妇女，初步的焦点小组工作将进一步完善干预措施。一个关键组成部分是它们在一般实践中的可行性。该试点将为未来的试验产生样本量估计，其主要结果将是降低糖尿病的发病率。这些项目解决了由于产妇年龄增加和肥胖以及糖尿病发病率上升而不断增加的妊娠期糖尿病发病率，糖尿病是一个主要的公共卫生问题。

DESCRIPTION (provided by applicant): Candidate: The candidate received her M.D. and M.P.H. from Columbia University, performed her internal medicine residency at the University of California, San Francisco, and completed a Robert Wood Johnson Clinical Scholars fellowship in health services research. She currently practices women's health care in Obstetrics & Gynecology, and she is interested in a research career improving the quality of care for women with glucose intolerance. Sponsor and Environment: William Herman, M.D. M.P.H., a diabetologist and the Michigan Diabetes Research and Training Director, has trained numerous investigators in the field of diabetes epidemiology and health services. Dr. Herman is PI of the Translating Research Into Action for Diabetes (TRIAD) Study, which examines the quality of diabetes care. He is quite familiar with the research methods proposed in this project and will oversee Dr. Kim's formal education. Research: The long-term goal of this proposal is to improve the quality of care for women with glucose intolerance, particularly women with gestational diabetes (GDM), or glucose intolerance first recognized during pregnancy. Twenty percent of women with GDM develop type 2 diabetes (DM) within 5 years after delivery. It is unknown if modest prevention strategies would be effective in women with GDM to prevent DM. First, Dr. Kim will examine the current quality of care for women with a history of GDM. Specifically, she will examine the counseling given for DM prevention and available resources for DM prevention, and correlation with patient and physician characteristics. This study will use a cross-sectional design, consisting of women with a history of GDM (n=400). Information will be obtained primarily from patient and physician surveys. This study will use the infrastructure of the TRIAD study for subject identification, data collection, and analysis. The candidate will then conduct a pilot study randomizing women with GDM to usual care vs. an intervention (group- or telephone support) (n=100). We will adapt existing interventions to women with GDM, and preliminary focus group work will further refine the interventions. A key component is their feasibility in general practice. The pilot will generate sample size estimates for a future trial, whose main outcome will be reduced incidence of DM. These projects address the growing incidence of GDM, which is increasing due to advancing maternal age and obesity, as well as the increasing rates of DM, a major public health problem.