Individualizing Treatment for Nursing Home Residents with Diabetes Mellitus

描述(由申请人提供)：理由：糖尿病(DM)在疗养院(NH)人群中变得越来越常见。然而，糖尿病患者的最佳血糖控制水平仍存在很大的不确定性。我们的广泛目标是建立一个证据基础，以个性化和改善对糖尿病患者的护理。研究目的：我们的目标是(1)确定全国退伍军人事务部(VA)NHS样本中目前的血糖控制做法，(2)确定血糖控制水平是否与失禁和摔倒等老年结果有关，以及(3)探索NH居民的治疗目标和个人对治疗(如胰岛素)和结果的偏好。职业目标/目的：这些项目将使PI能够发展专业知识(1)将电子病历数据用于临床研究，以及(2)进行定性研究，以获得患者的价值和偏好。研究设计/方法：对于目标1和目标2，我们将获得所有退伍军人管理局NHS的实验室、药学和结果数据。我们将通过确定患有糖尿病的VA NH居民接受特定治疗(例如胰岛素或口服药物)和直接并发症(例如低血糖)的比例来确定当前的做法。然后，我们将确定并发症和老年结局是否与HbA1c水平有关，并按治疗进行分层。对于目标3，我们将对旧金山退伍军人事务部和旧金山犹太之家的居民进行半结构化访谈，以了解他们对糖尿病治疗和结果的价值观和偏好。与公共健康相关：通过确定当前的做法以及血糖控制水平与大小便失禁等老年结果之间的关系，我们将为患者和临床医生提供信息，使他们能够就NH的糖尿病护理做出个性化决定。此外，通过强调关系和共同的患者偏好，我们的工作将获得数据，以支持未来实施工具的研究，以促进糖尿病患者的个性化决策。 公共卫生相关性：通过确定当前的做法以及血糖控制水平与大小便失禁等老年结果之间的关系，我们将为患者和临床医生提供信息，使他们能够在NH做出关于糖尿病护理的个性化决定。此外，通过强调关系和共同的患者偏好，我们的工作将获得数据，以支持未来实施工具的研究，以促进糖尿病患者的个性化决策。

DESCRIPTION (provided by applicant): Rationale: Diabetes mellitus (DM) is becoming increasingly common in the nursing home (NH) population. However, there is great uncertainty about the optimal level of glycemic control for NH residents with DM. Our broad objective is to develop an evidence base to individualize and improve the care for NH residents with DM. Research Aims: Our aims are to (1) determine the current practices for blood sugar control in a national sample of veterans affairs (VA) NHs, (2) determine whether the level of glycemic control is associated with geriatric outcomes such as incontinence and falls and (3) explore the goals of treatment and preferences of individual NH residents regarding treatments (e.g. insulin) and outcomes. Career Objectives/Aims: These projects will allow the PI to develop expertise (1) using electronic medical record data for clinical research and (2) performing qualitative research eliciting patient values and preferences. Research Design/Methods: For Aims 1 and 2, we will obtain laboratory, pharmacy and outcomes data for all VA NHs. We will determine current practices by determining the proportion of VA NH residents with diabetes who are getting specific treatments (e.g. insulin or oral medications) and direct complications (e.g. hypoglycemia). We will then determine whether complications and geriatric outcomes are associated with HbA1c levels, stratified by treatment. For Aim 3, we will conduct semi-structured interviews with residents of the San Francisco VA NH and the Jewish Home of San Francisco to elicit their values and preferences regarding DM treatments and outcomes. Relevance to Public Health: By determining the current practices and the relationship between the level of blood sugar control and geriatric outcomes such as incontinence, we will provide information for patients and clinicians so that they can make individualized decisions about diabetes care in the NH. Further, by highlighting relationships and common patient preferences, our work will obtain data to support future studies implementing tools to promote individualized decision making for NH residents with diabetes. PUBLIC HEALTH RELEVANCE: By determining the current practices and the relationship between the level of blood sugar control and geriatric outcomes such as incontinence, we will provide information for patients and clinicians so that they can make individualized decisions about diabetes care in the NH. Further, by highlighting relationships and common patient preferences, our work will obtain data to support future studies implementing tools to promote individualized decision making for NH residents with diabetes.