Predicting Severe Hypoglycemia among Older Adults with Diabetes

描述（由申请人提供）：超过一千万的美国老年人患有糖尿病，几乎所有人都服用药物来降低血糖水平。作为这种治疗的结果，这些患者中的许多人经历了严重的低血糖，这与包括死亡率在内的不良结局相关。为了提高糖尿病护理质量，我们需要优化治疗策略，减少这些可预防的并发症。然而，几乎没有信息可以帮助描述患者发生严重低血糖的风险。临床医生和患者在做出可能危及生命的治疗决定时，基本上都是在黑暗中操作，没有可靠的证据。我的目标是生成这些证据，帮助老年患者了解他们面临的风险，以便他们能够在治疗中做出更明智的决策，并最终实现对他们最重要的结果。我的假设是，一个简单的临床风险评分可以帮助确定哪些人是严重低血糖的最大风险。此外，该风险评分可以被纳入电子医疗记录系统，以改善治疗决策并优化糖尿病管理。我的研究有3个具体目标：1）估计老年2型糖尿病患者严重低血糖的年发生率（总体和治疗类型）; 2）开发和验证严重低血糖的临床风险评分; 3）进行试点研究，以评估在临床遇到期间使用风险评分的可行性，并评估其对治疗决策的影响。我的职业目标是成为一名独立的研究者和国家领导人，专注于老年糖尿病患者的成果研究。我是一名内分泌学家，有着早期成功的记录，包括GEMSSTAR R 03奖。我有一个杰出的导师团队，他们是成果研究（哈兰克鲁姆霍尔茨博士）、老年医学（托马斯吉尔博士）和糖尿病（西尔维奥·因祖奇博士）领域的国家领导人。在他们的指导下，我组装了一套理想的数据资产来实现我的目标。在获奖期间，我将获得生物统计方法，主要数据收集和混合方法研究方面的技能，并使用实施科学方法来学习如何最好地将我的研究结果带入临床护理。作为培训的一部分，我还将领导医疗保险和医疗补助服务中心制定糖尿病护理质量措施。我在Beeson申请中提出的工作是创新的，因为我打算改变老年人糖尿病管理的范式-从对血糖控制的强烈关注到对患者重要结果的更平衡的检查，包括治疗的不良反应。我计划在老龄化研究、成果研究和Optum实验室的领导者之间建立战略伙伴关系，Optum实验室拥有一个规模和范围都非常大的未开发数据库。该团队可以通过提供目前不存在但急需的信息来重新定义老年2型糖尿病患者的治疗。

DESCRIPTION (provided by applicant): More than ten million older Americans have diabetes and nearly all take medications to lower glucose levels. As a result of this treatment, many of these patients experience severe hypoglycemia, which is associated with poor outcomes including mortality. In order to improve the quality of diabetes care, we need to optimize treatment strategies and reduce these preventable complications. Yet, little information exists to help characterize a patient's risk for severe hypoglycemia. Clinicians and patients are essentially operating in the dark-without reliable evidence-when making important decisions about treatments with potentially life- threatening consequences. My goal is to generate that evidence and help older patients understand the risks they face so they can make more informed decisions about the trade-offs in treatment and, ultimately, achieve the outcomes that matter most to them. My hypothesis is that a simple clinical risk score can help identify which individuals are at greatest risk for severe hypoglycemia. Furthermore, this risk score can be incorporated into an electronic medical record system to improve treatment decisions and optimize diabetes management. My research has 3 specific aims: 1) estimate the annual incidence of severe hypoglycemia among older adults with type 2 diabetes (overall and by type of therapy); 2) develop and validate a clinical risk score for severe hypoglycemia; and 3) conduct a pilot study to assess the feasibility of using the risk score during clinical encounters and to assess its impact on treatment decisions. My career goals are to become an independent investigator and a national leader with expertise in outcomes research focusing on older adults who have diabetes. I am an endocrinologist with a track record of early success, including a GEMSSTAR R03 award. I have an exceptional team of mentors who are national leaders in outcomes research (Dr. Harlan Krumholz), geriatrics (Dr. Thomas Gill), and diabetes (Dr. Silvio Inzucchi). With their guidance, I have assembled an ideal set of data assets to address my aims. During the award period, I will gain skills in biostatistical methods, primary data collectio, and mixed methods research, and use implementation science methods to learn how to best bring my findings into clinical care. As part of my training, I will also lead the development of diabetes quality of care measures for the Centers of Medicare and Medicaid Services. The work proposed in my Beeson application is innovative because I intend to shift the paradigm of diabetes management among older individuals - from an intense focus on glucose control to a more balanced examination of patient-important outcomes, including adverse effects of therapies. I plan to forge strategic partnerships between leaders in aging research, outcomes research, and Optum Labs - which has an untapped database of extraordinary size and scope. This team can redefine the treatment of older patients with type 2 diabetes, by providing information that is currently nonexistent and yet critically needed.