Toward personalized diabetes care: Understanding hypoglycemia in older adults

实现个性化糖尿病护理：了解老年人的低血糖症

基本信息

批准号：
8555728
负责人：
Kasia Joanna Lipska
金额：
$ 8.33万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-08-15 至 2015-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8555728
关键词：
Accident and Emergency department Address Admission activity Adopted Adult Adverse effects Adverse event African American Age Aging Ambulatory Care Appointment Benefits and Risks California Cardiovascular system Caring Clinical Clinical Investigator Complex Data Data Collection Databases Dementia Diabetes Mellitus Elderly Epidemiology Equilibrium Ethnic Origin Event Fracture Future Geographic Locations Geriatrics Glucose Glycosylated hemoglobin A Goals Guidelines Health Healthcare Healthcare Systems Hispanics Hospital Referrals Hospitalization Hospitals Hyperglycemia Hypoglycemia Hypoglycemic Agents Impaired cognition Impairment Insulin Intervention Interview Kidney Knowledge Lead Learning Measures Medical Medicare Metric Morbidity - disease rate Outcome Participant Patient Self-Report Patients Performance Persons Pharmaceutical Preparations Precipitating Factors Predisposing Factor Prevention Provider Proxy Qualitative Methods Qualitative Research Quality of Care Quality of life Race Registries Relaxation Research Research Methodology Rewards Risk Risk Factors Safety Sampling Sex Characteristics Subgroup Symptoms System Taxonomy Testing Time Transportation Visual impairment Work base blood glucose regulation career clinical practice cohort community setting control trial cost diabetes mellitus therapy diabetic epidemiologic data experience fall risk geographic difference glycemic control health care delivery high risk improved insight insulin secretagogues medical attention mortality older patient prevent racial difference regional difference sex skills trend

项目摘要

DESCRIPTION (provided by applicant): Hypoglycemia is the most common adverse effect of diabetes treatment. Severe hypoglycemia is more frequent in older adults than their younger counterparts and is associated with increased risk of falls, fractures, dementia, cardiovascular events, mortality, and poor quality of life. Diabetes care quality metrics focus almost exclusively on prevention of hyperglycemia and its complications and reward target-based glucose lowering - this can potentially lead to one-size-fits-all clinical practice and an increase in adverse event. Recent clinical guidelines call for individualized goal-setting in diabetes care, but data on how t personalize care to maximize benefits and minimize adverse events are lacking. A clear and comprehensive understanding of the burden of hypoglycemia on patients and a rigorous examination of risk factors for hypoglycemia are required to inform treatment decisions in older persons with diabetes, assess an important aspect of current quality of care, and provide future targets for intervention that may mitigate the burden of hypoglycemia. The candidate's career goal is to become an independent clinical investigator in the field of diabetes and geriatrics, generating knowledge to help guide personalized diabetes treatment. In this proposal, the candidate will apply rigorous epidemiologic, biostatistical, and qualitative research methods to evaluate older patients who experience severe hypoglycemia, identify potential contributors to hypoglycemia admissions, and examine the relationship between specific glucose targets, glucose-lowering therapies and hypoglycemic events in order to provide better information on treatment-related adverse events and improve clinical outcomes. Specific Aim 1: To characterize recent trends in hospital admissions for hypoglycemia among older Medicare recipients with diabetes for a 12-year period from 1998-2010, and to examine race, gender, and geographic differences in these trends. Specific Aim 2: To elucidate factors that may contribute to the risk of hospitalization for hypoglycemia among a sample of older adults with diabetes using qualitative methods. Specific Aim 3: To evaluate the association between glycemic control, glucose-lowering agents, and hypoglycemic events in the Diabetes Study of Northern California (DISTANCE), a multiethnic cohort of 20,000 patients with diabetes in a large integrated healthcare delivery system. The combination of a large scale surveillance approach, primary data collection to investigate potential reasons for hypoglycemia hospital admissions, and a detailed analysis of a clinical registry will provide the candidate with additional skills in large database analyses, qualitative research methods, and epidemiologic aging research - and will lead to future work to comprehensively understand the balance of risks and benefits of glucose-lowering therapy in older adults.

描述（由申请人提供）：低血糖是糖尿病治疗的最常见不良影响。老年人中严重的低血糖比年轻的低血糖更常见，并且与跌倒，骨折，痴呆，心血管事件，死亡率和生活质量差的风险增加有关。糖尿病护理质量指标几乎完全关注关于预防高血糖及其并发症和基于奖励靶基的葡萄糖的降低 - 这可能会导致一小中的所有临床实践和不良事件的增加。最近的临床准则要求在糖尿病护理中实现个性化目标，但是有关如何个性化护理以最大程度地提高收益和最大程度地减少不良事件的数据。需要清楚而全面地了解低血糖对患者的负担以及对低血糖危险因素的严格检查，以便为糖尿病老年人的治疗决策提供信息，评估当前护理质量的重要方面，并为可能减轻低血糖负担的干预目标提供未来的目标。候选人的职业目标是成为糖尿病和老年医学领域的独立临床研究者，从而产生知识，以帮助指导个性化的糖尿病治疗。在该建议中，候选人将采用严格的流行病学，生物统计学和定性研究方法来评估患有严重低血糖的老年患者，确定对低血糖症入院的潜在贡献者，并检查特定的葡萄糖靶标之间的关系，葡萄糖降低治疗疗法和降低葡萄糖疗法的临床范围和临床治疗方面的治疗范围和临床范围较高的事件。具体目的1：表征从1998 - 2010年为期12年的糖尿病老年医疗保险接受者中低血糖的医院入院率的最新趋势，并检查这些趋势的种族，性别和地理差异。具体目的2：阐明可能导致使用定性方法患有糖尿病的老年人样本中低血糖症的住院风险的因素。特定目的3：评估北加州糖尿病研究中血糖控制，降糖药物和降血糖事件之间的关联，北加州（距离）是一个多种族组，由20,000例糖尿病患者组成的大型综合医疗保健系统中的糖尿病患者。大规模监视方法的结合，主要数据收集以调查低血糖医院入院的潜在原因以及对临床注册中心的详细分析将为候选人提供其他技能大型数据库分析，定性研究方法和流行病学衰老研究 - 将导致未来的工作，以全面了解老年人的风险和降低葡萄糖疗法的平衡。