Contributions of Hypoglycemia and Hyperglycemia to Adverse Geriatric Outcomes in NH Residents with Diabetes and Alzheimer's Disease and Related Dementias (ADRD)

项目摘要/摘要 疗养院(NH)患有2型糖尿病的居民有大量并发糖尿病的多发病 管理层。阿尔茨海默病和相关痴呆症影响了近50%的NH居民，并可能 增加低血糖的风险。目前的NH糖尿病管理指南没有针对阿尔茨海默氏症 疾病和相关痴呆症以及目前对NH目标血糖范围的建议基于 基于专家意见，而不是在某些血糖阈值下的不利老年结果的证据。至 针对这些弱点，我们提出了以下目标：1)比较低血压病和低血压病的发病率 2)观察低血糖和高血糖对老年痴呆患者的急性影响。 老年综合征和评估阿尔茨海默病和相关痴呆是否改变血糖 阈值，以及3)检查低血糖和高血糖对认知功能下降和 功能衰退，并确定阿尔茨海默病和相关痴呆的基线严重程度 修改血糖阈值。拟议的研究利用了现有的退伍军人事务部电子健康 记录数据库，这是常规手指血糖测量的唯一来源。这样做的长期目标是 研究是建立具有低血糖阈值的NH特异性目标血糖范围和 导致阿尔茨海默病和相关痴呆症的高血糖。李博士寻求一种 K01导师研究科学家发展奖，以获得基本技能和导师研究 经验，将开始她的职业生涯作为一名独立研究员在老龄化，糖尿病，和 阿尔茨海默病和相关痴呆症。五年培训计划将填补老年医学方面的内容空白 在HER基础上对阿尔茨海默病和相关痴呆的症状和评估 包括先进的因果推论方法和使用电子健康记录的方法优势 用于研究。李博士将在加州大学旧金山分校丰富的培训环境中完成拟议的研究 老年医学，由老年医学卫生服务研究员Sei Lee博士，医学博士，MAS， 加州大学旧金山分校老年病学教授，痴呆症专家Kristine Yaffe博士，医学博士， 加州大学旧金山分校的精神病学、神经学和流行病学，老年流行病学家米歇尔·奥登博士， 斯坦福大学卫生研究和政策系流行病学副教授。使用 在她的导师、合作导师和尊敬的顾问的支持下，李博士将成功地迈向 竞争R01资金，成为老年糖尿病领域的领导者。

Project Summary/Abstract Nursing home (NH) residents with type 2 diabetes have substantial multimorbidity that complicates diabetes management. Alzheimer's Disease and related dementias affects nearly 50% of NH residents and may increase risk of hypoglycemia. Current NH diabetes management guidelines do not address Alzheimer's Disease and related dementias and current recommendations for NH target blood glucose ranges are based on expert opinion rather than evidence of adverse geriatric outcomes at certain thresholds of glycemia. To address these weaknesses, we propose the following aims: 1) to compare the incidence rates of hypo- and hyper-glycemia in the NH by dementia status, 2) to examine the acute effects of hypo- and hyper-glycemia on geriatric syndromes and evaluate whether Alzheimer's Disease and related dementias modifies glycemic thresholds, and 3) to examine the cumulative effects of hypo- and hyper-glycemia on cognitive decline and functional decline, and to determine whether baseline severity of Alzheimer's Disease and related dementias modifies glycemic thresholds. The proposed research leverages existing Veterans Affairs electronic health record databases, a unique source of routine fingerstick glucose measurements. The long-term goal of this research is to establish NH-specific target blood glucose ranges with thresholds of hypoglycemia and hyperglycemia that account for the presence of Alzheimer's Disease and related dementias. Dr. Lee seeks a K01 Mentored Research Scientist Development Award to obtain essential skills and mentored research experience that will launch her career as an independent investigator in the field of aging, diabetes, and Alzheimer's Disease and related dementias. The five-year training plan will fill content gaps in geriatric syndromes and the assessment of Alzheimer's Disease and related dementias while building on her methodological strengths to include advanced causal inference methods and using electronic health records for research. Dr. Lee will complete the proposed research in the rich training environment of the UCSF Division of Geriatrics, with primary mentorship from geriatrics health services researcher Dr. Sei Lee, MD, MAS, Professor of Geriatrics at UCSF, co-mentorship by dementia expert Dr. Kristine Yaffe, MD, Professor of Psychiatry, Neurology and Epidemiology at UCSF, and aging epidemiologist Dr. Michelle Odden, PhD, Associate Professor of Epidemiology in the Division of Health Research and Policy at Stanford University. With the support of her mentors, co-mentors, and esteemed advisors, Dr. Lee will advance towards successfully competing for R01 funding and becoming a leader in geriatric diabetes.