Race/ethnic Differences Among Older Patients with Type 2 Diabetes at Risk for Hypoglycemia

项目摘要 许多患有2型糖尿病(T2D)的老年人由于强化T2D而经历危险的低血糖 药物治疗。降低治疗强度的决定必须根据患者的喜好和 价值观。教育患者并培养他们的沟通技能以表达他们的偏好的新工具提供了 改善高危老年人T2D护理安全性的前景看好的策略。该R01奖的目标是 将价值观启发和沟通和决策技能培养的原则应用于具体的 易受伤害老年患者低血糖相关不良结局的临床问题。该计划的目标是 家长R01将开发一个在线工具，专门解决老年人的T2D治疗强度 增加低血糖事件的风险，然后进行一项随机试验来评估这一方法的有效性 减少75岁高危患者低血糖事件的新工具≥。我们的支持方法 价值导向护理代表了一种创新的、具有广泛应用潜力的方法，可以帮助老年人 根据他们的目标和偏好做出明智的决定。如果成功，这个框架可以扩展 并应用于各种医疗保健环境和慢性疾病中，在这些环境中， 治疗的后果需要随着年龄的增长而重新评估。达纳·阿布德尔加迪尔通过 这一行政副刊将为项目提供极好的机会，以便进行更详细的 对我们临床试验中的非裔美国人参与者的分析(约12%的预期参与者， 与北加州的来源人口比例相似)，允许更多地强调 研究老年非裔美国糖尿病患者的相似之处和独特之处 与卫生保健系统和目前与药物有关的做法。进一步的研究集中在老年人身上 我们试验中的非裔美国人有可能为如何最好地吸引这名患者提供有用的见解 人口参与旨在提高参与度和降低用药风险的研究。拟议的研究 与家长拨款的主要目标直接相关，同时也通过延长我们的 非洲裔美国人患者的对比分析。这项研究涉及NIH的三个优先事项 将证据转化为实践，提高用药安全性，并了解医疗保健差异。这个 在低于限额少数群体行政补编内提出的具体项目将侧重于 对患有2型糖尿病风险增加的老年非裔美国人进行了更详细的检查 低血糖症。这项补充工作将进一步深入了解潜在的差异和独特的 老年非裔美国人在初级保健就诊期间面临的沟通障碍。

Project Summary Many older adults with type 2 diabetes (T2D) experience dangerous hypoglycemic due to intensive T2D medication treatment. The decision to reduce treatment intensity must be informed by patient preferences and values. New tools that educate patients and build their communication skills to voice their preferences offer a promising strategy for improving the safety of T2D care in high risk older adults.The goal of this R01 award is to apply principles of values elicitation and skill building for communication and decision making to the specific clinical problem of hypoglycemia-related adverse outcomes in vulnerable older patients. The aims of the parent R01 are to develop an online tool to specifically address T2D treatment intensity in older adults at increased risk for hypoglycemic events, and to then conduct a randomized trial to assess the efficacy of this new tool to reduce hypoglycemia events among high risk patients ≥ 75 years of age. Our approach to support value-aligned care represents an innovative and potentially widely applicable method to help older adults to make informed decisions based on their goals and preferences. If successful, this framework could be scaled and applied in a wide variety of healthcare settings and chronic conditions in which evolving risks, benefits, and consequences of treatment require re-assessment with age. The addition of Dana Abdelgadir through this Administrative Supplement will provide the project with the excellent opportunity to conduct more detailed analyses of African American participants in our clinical trial (approximately 12% of expected participants, similar proportion to the source population in Northern California) by allowing an increased emphasis on examining the similarities and unique differences in how older African American patients with diabetes engage with the health care system and to current medication-related practices. Further study focused on older African Americans in our trial has the potential to provide useful insight into how to best engage this patient population in research designed to improve engagement and reduce medication risk. The proposed research is directly related to the main goals of the parent grant while also broadening our project by extending our comparative analyses of African American patients. This study addresses the three NIH priorities of translating evidence into practice, improving medication safety, and understanding health care disparities. The specific project proposed within the Under-Represented Minority (URM) Administrative Supplement will focus on a more detailed examination of older African American patients with type 2 diabetes at increased risk for hypoglycemia. This supplemental work will provide further insight into the potential disparities and unique barriers to communication faced by older African Americans during primary care visits.