Effective Inpatient Diabetes Management and the Transition to Outpatient Care

描述(由申请人提供)： 最近的试验证明了在ICU环境下强化血糖控制的好处，并将注意力集中在非ICU住院期间的血糖控制上。在住院普通内科或外科病房实现严格的血糖控制尚无数据支持；其追求是资源密集型的，可能存在风险。除了住院糖尿病管理带来的紧急好处外，住院治疗还为每年住院的25%的糖尿病患者提供了改善出院后护理的机会。候选人的职业目标是成为一名独立的糖尿病临床研究人员，专注于将循证指南转化为有效的糖尿病护理。在这份提案中，候选人将学习将严格的流行病学、生物统计学和临床试验研究方法应用于住院糖尿病管理和从住院到门诊护理的过渡问题。拟议的研究将为更大规模的试验建立初步数据，以改善住院糖尿病患者的护理，并利用住院作为优化这些患者的整体护理的机会。具体目标1：在一大群普通住院糖尿病患者(1型或2型)中检查高血糖和低血糖的危险因素和处理，并检查住院糖尿病患者护理与出院后血糖控制的关系。具体目标2：使用连续血糖监测(CGM)确定住院糖尿病患者高血糖和低血糖的真实患病率，并建立住院患者血糖监测和报告频率的循证标准。具体目标3：对糖尿病控制不佳的住院患者进行随机对照试验，比较住院药物滴定、患者教育和促进门诊过渡与常规护理策略对出院6个月后门诊血糖控制的影响。这一职业发展奖将帮助候选人在国际知名研究人员的指导下，在支持性的学术环境中获得更多的研究技能和经验，并将使她实现成为一名独立的、以患者为导向的糖尿病护理研究人员的目标。

DESCRIPTION (provided by applicant): Recent trials demonstrating the benefits of intensive glycemic control in the ICU setting have focused attention on glycemic control during non-ICU hospitalizations. Achieving tight glycemic control in inpatient general medical or surgical wards is not yet supported by data; its pursuit is resource-intensive and may be risky. Independent of the acute benefits of inpatient diabetes management, hospitalization offers an opportunity to improve care after discharge for the 25% of all patients with diabetes who are hospitalized annually. The candidate's career goal is to become an independent clinical researcher in diabetes with a focus on translating evidence-based guidelines into effective diabetes care. In this proposal the candidate will learn to apply rigorous epidemiologic, biostatistical, and clinical trial research methods to the problems of inpatient diabetes management and the transition from inpatient to outpatient care. The proposed studies will establish the preliminary data for larger trials to improve inpatient diabetes care and to use the hospital admission as an opportunity to optimize overall care in these patients. Specific Aim 1: To examine risk factors for and management of hyper- and hypoglycemia among a large cohort of general inpatients with diabetes (Type 1 or Type 2) and to examine the relationship of inpatient diabetes care to glycemic control after discharge. Specific Aim 2: To determine the true prevalence of hyper- and hypoglycemia in inpatients with diabetes using continuous glucose monitoring (CGM) and to establish an evidence-based standard for frequency of monitoring and reporting of inpatient glycemia. Specific Aim 3: To perform a randomized controlled trial in hospitalized patients with poorly controlled diabetes comparing the impact of a strategy of inpatient medication titration, patient education, and facilitated outpatient transition vs. usual care on outpatient glycemic control 6 months after discharge. This career development award will help the candidate to acquire additional research skills and experience under the mentorship of internationally known researchers in a supportive academic environment and will allow her to achieve her goal of becoming an independent patient-oriented researcher in diabetes care.