Heterogeneity, Glycemic Control & Macro-Vascular Complications in Type 2 Diabetes

异质性，血糖控制

• 批准号: 7433322
• 负责人: CHEN-PIN WANG
• 金额: $ 11.4万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-06-01 至 2011-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7433322
• 关键词: Adherence; Affect; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Behavior; Blood Pressure; Blood Vessels; Body mass index; Cardiovascular Diseases; Cardiovascular system; Characteristics; Chronic Disease; Class; Clinical; Complex; Complications of Diabetes Mellitus; Consultations; Control Groups; Data; Depth; Development; Diabetes Mellitus; Diagnosis; Diet Modification; Dyslipidemias; Environment; Etiology; Formularies; Functional disorder; Funding Agency; Glucose; Glycosylated Hemoglobin; Glycosylated hemoglobin A; Goals; Health Insurance; Health Policy; Health Services Research; Healthcare; Heterogeneity; Hyperglycemia; Hyperinsulinism; Hypertension; Incidence; Individual; Insulin; Insurance Coverage; Intervention; Intervention Studies; Lipids; Literature; Measures; Mediating; Mentors; Methodology; Methods; Modeling; Morbidity - disease rate; Non-Insulin-Dependent Diabetes Mellitus; Patients; Pharmaceutical Preparations; Prevention; Prevention strategy; Provider; Purpose; Rate; Research; Research Personnel; Research Training; Risk Factors; Smoking Status; Socioeconomic Status; Statistical Methods; Techniques; Terminology; Testing; Time; Training; Training Programs; Weight maintenance regimen; Work; base; blood glucose regulation; cardiovascular disorder prevention; cardiovascular disorder risk; career; cohort; demographics; design; diabetic; evidence based guidelines; experience; glycemic control; improved; insight; insulin secretagogues; insulin sensitivity; insulin sensitizing drugs; macrovascular disease; medication compliance; mortality; response; skills; smoking cessation; statistics; symposium; theories

DESCRIPTION (provided by applicant): I have extensive experience in robust statistical methods to study complex heterogeneities (referring to differential effects or association) arising from longitudinal data. My recent work suggested the potential of such methods for advancing the research on macrovascular complications/cardiovascular diseases (CVD) in type 2 diabetes (T2DM). My career goal is to develop an independent research career in statistical methods pertinent to the design and testing of interventions aimed at reducing diabetes-related CVD for patients with T2DM. The primary purpose of this proposal is to support an integrated program of training and research to achieve this goal. My career development objectives are to: 1) acquire an in-depth understanding of T2DM regarding its diagnosis, etiology, pathophysiology, and treatment methods and the associated pharmacological theories;2) acquire an in-depth understanding of T2DM related CVD, especially regarding their etiology, diagnosis, and prevention theories; 3) gain insights from the health services research perspective about factors that may influence providers' implementation of evidence-based guidelines and patients' choices of treatment and adherence behaviors; 4) enhance my statistical skills for developing efficient and robust estimation methods; and 5) enhance my skills for communicating quantitative methods and analytic results with clinicians, clinical researchers, funding agencies, and health policy analysts. The objectives will be met through formal coursework, dyadic mentoring, consultation, seminars and conferences on diabetes and CVD research as well as in Bayesian statistics methodology. For the research proposed, I will apply the general latent variable modeling technique to examine the differential relationship between glycemic control and CVD due to medication adjustments for hyperglycemia, dyslipidemia, and hypertension in a longitudinal clinical cohort of type 2 diabetics. For the purpose of identifying effective strategies for prevention of CVD, I will further develop my statistical expertise to obtain efficient estimates of the differential medication effects on CVD risk, which are mediated through improving glycemic control, hyperinsulinemia, or insulin sensitivity. This research will take advantage of my access to a rich set of longitudinal data available in my current research environment in the VA and the experience of my mentors. Findings of the study will provide further insights about why the field has not yet reached a firm conclusion about the association between "tight glucose control" and CVD, the leading cause of morbidity and mortality in type 2 diabetics. Specifically, the results will inform how CVD intervention strategies should vary across individuals with different characteristics.

描述（由申请人提供）： 我在稳健的统计方法方面有丰富的经验，可以研究纵向数据产生的复杂异质性（指差异效应或关联）。我最近的工作表明，这种方法有可能推进2型糖尿病（T2 DM）大血管并发症/心血管疾病（CVD）的研究。我的职业目标是在统计方法方面发展独立的研究生涯，这些方法与旨在减少T2 DM患者糖尿病相关CVD的干预措施的设计和测试有关。本提案的主要目的是支持一个培训和研究的综合方案，以实现这一目标。我的职业发展目标是：1）深入了解T2 DM的诊断、病因、病理生理学和治疗方法以及相关的药理学理论;2）深入了解T2 DM相关的心血管疾病，特别是其病因、诊断和预防理论; 3）从卫生服务研究的角度了解可能影响提供者实施循证指南以及患者选择治疗和依从行为的因素; 4）提高我的统计技能，以开发有效和可靠的估计方法; 5）提高我与临床医生，临床研究人员，资助机构和卫生政策分析师交流定量方法和分析结果的技能。这些目标将通过正式的课程，二元辅导，咨询，研讨会和会议糖尿病和心血管疾病的研究以及贝叶斯统计方法来实现。对于所提出的研究，我将应用一般潜变量建模技术，以检查血糖控制和心血管疾病之间的差异关系，由于高血糖，血脂异常，高血压的药物调整，在2型糖尿病患者的纵向临床队列。为了确定预防CVD的有效策略，我将进一步发展我的统计学专业知识，以获得对CVD风险的差异药物效应的有效估计，这些效应是通过改善血糖控制、高胰岛素血症或胰岛素敏感性来介导的。这项研究将利用我在弗吉尼亚州目前的研究环境中获得的一组丰富的纵向数据和我的导师的经验。这项研究的结果将进一步解释为什么该领域尚未就“严格血糖控制”与CVD（2型糖尿病发病率和死亡率的主要原因）之间的关联得出明确结论。具体而言，研究结果将告知CVD干预策略应如何在具有不同特征的个体之间变化。