Contributions of Hypoglycemia and Hyperglycemia to Adverse Geriatric Outcomes in NH Residents with Diabetes and Alzheimer's Disease and Related Dementias (ADRD)

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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.