Type 2 Diabetes Risk in Women With Gestational Diabetes

描述（由申请人提供）： 候选人：候选人获得了医学博士学位。和MPH来自哥伦比亚大学，在加州大学旧金山弗朗西斯科进行内科住院医师实习，并完成了卫生服务研究方面的Robert Wood约翰逊临床学者奖学金。她目前在妇产科从事妇女保健工作，她对提高葡萄糖耐受不良妇女保健质量的研究事业感兴趣。申办方和环境：William赫尔曼，医学博士M.P.H.糖尿病学家和密歇根糖尿病研究和培训主任，已经培训了许多糖尿病流行病学和卫生服务领域的研究人员。赫尔曼博士是将糖尿病研究转化为行动（TRIAD）研究的PI，该研究检查糖尿病护理的质量。他非常熟悉这个项目中提出的研究方法，并将监督金博士的正规教育。调研：该提案的长期目标是提高对葡萄糖耐受不良妇女的护理质量，特别是妊娠期糖尿病（GDM）或在妊娠期间首次发现的葡萄糖耐受不良妇女。20%的GDM女性在分娩后5年内发展为2型糖尿病（DM）。目前尚不清楚适度的预防策略是否对GDM女性有效。首先，金博士将研究目前的护理质量与GDM的历史妇女。具体来说，她将研究为糖尿病预防提供的咨询和糖尿病预防的可用资源，以及与患者和医生特征的相关性。本研究将采用横断面设计，包括有GDM病史的女性（n=400）。信息将主要从患者和医生调查中获得。本研究将使用TRIAD研究的基础设施进行受试者识别、数据收集和分析。然后，候选人将进行一项试点研究，将GDM女性随机分为常规护理与干预（小组或电话支持）（n=100）。我们将调整现有的干预措施，以适应患有GDM的妇女，初步的焦点小组工作将进一步完善干预措施。一个关键的组成部分是它们在一般实践中的可行性。试点将为未来的试验产生样本量估计，其主要结果将是降低糖尿病的发病率。这些项目旨在解决由于产妇年龄增长和肥胖而日益增加的妊娠期糖尿病发病率，以及作为一个主要公共卫生问题的糖尿病发病率不断上升的问题。

DESCRIPTION (provided by applicant): Candidate: The candidate received her M.D. and M.P.H. from Columbia University, performed her internal medicine residency at the University of California, San Francisco, and completed a Robert Wood Johnson Clinical Scholars fellowship in health services research. She currently practices women's health care in Obstetrics & Gynecology, and she is interested in a research career improving the quality of care for women with glucose intolerance. Sponsor and Environment: William Herman, M.D. M.P.H., a diabetologist and the Michigan Diabetes Research and Training Director, has trained numerous investigators in the field of diabetes epidemiology and health services. Dr. Herman is PI of the Translating Research Into Action for Diabetes (TRIAD) Study, which examines the quality of diabetes care. He is quite familiar with the research methods proposed in this project and will oversee Dr. Kim's formal education. Research: The long-term goal of this proposal is to improve the quality of care for women with glucose intolerance, particularly women with gestational diabetes (GDM), or glucose intolerance first recognized during pregnancy. Twenty percent of women with GDM develop type 2 diabetes (DM) within 5 years after delivery. It is unknown if modest prevention strategies would be effective in women with GDM to prevent DM. First, Dr. Kim will examine the current quality of care for women with a history of GDM. Specifically, she will examine the counseling given for DM prevention and available resources for DM prevention, and correlation with patient and physician characteristics. This study will use a cross-sectional design, consisting of women with a history of GDM (n=400). Information will be obtained primarily from patient and physician surveys. This study will use the infrastructure of the TRIAD study for subject identification, data collection, and analysis. The candidate will then conduct a pilot study randomizing women with GDM to usual care vs. an intervention (group- or telephone support) (n=100). We will adapt existing interventions to women with GDM, and preliminary focus group work will further refine the interventions. A key component is their feasibility in general practice. The pilot will generate sample size estimates for a future trial, whose main outcome will be reduced incidence of DM. These projects address the growing incidence of GDM, which is increasing due to advancing maternal age and obesity, as well as the increasing rates of DM, a major public health problem.