Predicting Severe Hypoglycemia among Older Adults with Diabetes

描述(申请人提供)：1000多万美国老年人患有糖尿病，几乎所有人都在服用药物来降低血糖水平。作为这种治疗的结果，这些患者中的许多人经历了严重的低血糖，这与包括死亡率在内的不良结局有关。为了提高糖尿病护理的质量，我们需要优化治疗策略，减少这些可预防的并发症。然而，几乎没有信息可以帮助描述患者患严重低血糖的风险。临床医生和患者在对可能危及生命的后果的治疗做出重要决定时，基本上是在黑暗中操作--没有可靠的证据。我的目标是产生这些证据，帮助老年患者了解他们面临的风险，这样他们就可以对治疗中的权衡做出更明智的决定，最终获得对他们最重要的结果。我的假设是，一个简单的临床风险评分可以帮助确定哪些人患严重低血糖的风险最大。此外，这一风险评分可以纳入电子病历系统，以改进治疗决策和优化糖尿病管理。我的研究有3个具体目标：1)估计老年2型糖尿病患者严重低血糖的年度发病率(总体和按治疗类型)；2)开发和验证严重低血糖的临床风险评分；3)进行一项试点研究，以评估在临床接触中使用风险评分的可行性，并评估其对治疗决策的影响。我的职业目标是成为一名独立的调查员，成为一名在结果研究方面拥有专业知识的国家领导者，专注于患有糖尿病的老年人。我是一名内分泌学家，有早期成功的记录，包括GEMSSTAR R03奖。我有一个杰出的导师团队，他们是结果研究(Harlan Kruholz博士)、老年病学(Thomas Gill博士)和糖尿病(Silvio Inzucchi博士)方面的全国领导者。在他们的指导下，我收集了一套理想的数据资产来实现我的目标。在获奖期间，我将获得生物统计学方法、原始数据收集和混合方法研究方面的技能，并使用实施科学方法学习如何最好地将我的发现应用于临床护理。作为我培训的一部分，我还将领导为医疗保险和医疗补助服务中心制定糖尿病护理质量措施。我在Beeson申请中提出的工作是创新的，因为我打算改变老年人糖尿病管理的范式--从高度关注血糖控制转向更平衡地检查患者重要的结果，包括治疗的不良反应。我计划在老龄化研究、结果研究和Optom实验室领域的领导者之间建立战略合作伙伴关系-该实验室拥有一个超大规模和范围的尚未开发的数据库。这个团队可以通过提供目前不存在的、但迫切需要的信息来重新定义老年2型糖尿病患者的治疗。

DESCRIPTION (provided by applicant): More than ten million older Americans have diabetes and nearly all take medications to lower glucose levels. As a result of this treatment, many of these patients experience severe hypoglycemia, which is associated with poor outcomes including mortality. In order to improve the quality of diabetes care, we need to optimize treatment strategies and reduce these preventable complications. Yet, little information exists to help characterize a patient's risk for severe hypoglycemia. Clinicians and patients are essentially operating in the dark-without reliable evidence-when making important decisions about treatments with potentially life- threatening consequences. My goal is to generate that evidence and help older patients understand the risks they face so they can make more informed decisions about the trade-offs in treatment and, ultimately, achieve the outcomes that matter most to them. My hypothesis is that a simple clinical risk score can help identify which individuals are at greatest risk for severe hypoglycemia. Furthermore, this risk score can be incorporated into an electronic medical record system to improve treatment decisions and optimize diabetes management. My research has 3 specific aims: 1) estimate the annual incidence of severe hypoglycemia among older adults with type 2 diabetes (overall and by type of therapy); 2) develop and validate a clinical risk score for severe hypoglycemia; and 3) conduct a pilot study to assess the feasibility of using the risk score during clinical encounters and to assess its impact on treatment decisions. My career goals are to become an independent investigator and a national leader with expertise in outcomes research focusing on older adults who have diabetes. I am an endocrinologist with a track record of early success, including a GEMSSTAR R03 award. I have an exceptional team of mentors who are national leaders in outcomes research (Dr. Harlan Krumholz), geriatrics (Dr. Thomas Gill), and diabetes (Dr. Silvio Inzucchi). With their guidance, I have assembled an ideal set of data assets to address my aims. During the award period, I will gain skills in biostatistical methods, primary data collectio, and mixed methods research, and use implementation science methods to learn how to best bring my findings into clinical care. As part of my training, I will also lead the development of diabetes quality of care measures for the Centers of Medicare and Medicaid Services. The work proposed in my Beeson application is innovative because I intend to shift the paradigm of diabetes management among older individuals - from an intense focus on glucose control to a more balanced examination of patient-important outcomes, including adverse effects of therapies. I plan to forge strategic partnerships between leaders in aging research, outcomes research, and Optum Labs - which has an untapped database of extraordinary size and scope. This team can redefine the treatment of older patients with type 2 diabetes, by providing information that is currently nonexistent and yet critically needed.