The initial care of younger adults with newly diagnosed type 2 diabetes

项目总结 Anjali Gopalan博士，医学博士，MSHP，北加州凯撒永久医院董事会认证的内科医生 (KPNC)奥克兰医学中心和KPNC的一名一级研究科学家(相当于助理教授) 研究部(DOR)。有了拟议的K23导师职业发展奖，戈帕兰博士将 获得必要的高级培训和专业知识，成为一名独立的调查员，能够 并为早发性2型糖尿病(EOT2D)患者实施量身定制的干预措施。通过专注于 患有EOT2D的成年人，她试图解决相对较差的微血管和大血管结果 部分原因可能是对高血糖和其他心血管疾病管理不力 疾病风险因素。Gopalan博士的研究假设是，对于新诊断的 患者服用EOT2D以实现早期疾病控制，因为在接下来的一年中加强了血糖控制 诊断可以带来长期的微血管和大血管益处。为了支持这一前提，该研究 此K23的目的是：1)使用电子健康记录[EHR]数据来识别EOT2D患者亚组 早期疾病控制不足的最高风险，2)确定初始EOT2D的障碍和促进者 管理，以及3)检查患者报告的因素(例如，与疾病相关的)之间的前瞻性关联 痛苦、健康素养)和早期疾病控制不足。拟议的研究将得到以下方面的支持 经验丰富的导师和顾问，以及以下领域的高级培训：1)使用高级 统计建模，2)定性数据分析，为干预发展提供信息，3)社会的作用 健康中的决定因素，以及4)实施科学。KPNC和DOR是 建议的工作。KPNC是一个集成的学习型医疗保健提供系统，拥有4.2个不同的成员 百万人(35万糖尿病患者)。DOR在早期有效培训方面有很长的记录 调查人员，有完善的内部研究计划和与附近的合作关系 提供职业发展所需基础设施的机构。这种环境，以及 建议的研究和培训计划以及优秀的指导团队，将使Gopalan博士能够 继续培养技能并生成提交R01级建议书所需的基础数据 拟议奖励期的最后几年。在计划中的R01中，Gopalan博士将细化和实施 干预措施(设计基于三个K23研究目标的结果)，以改善早期护理 新诊断的EOT2D患者，并评估其对这一不断增长的高风险患者的早期预后的影响 人口。总之，拟议的K23奖将支持戈帕兰博士的职业发展， 对于她获得成为一名成功的独立调查员所需的技能和专业知识至关重要。

PROJECT SUMMARY Dr. Anjali Gopalan, MD, MSHP is a board-certified Internist at the Kaiser Permanente Northern California (KPNC) Oakland Medical Center and a Research Scientist I (equivalent to Assistant Professor) at the KPNC Division of Research (DOR). With the proposed K23 mentored career development award, Dr. Gopalan will gain the advanced training and expertise necessary to become an independent investigator who can develop and implement tailored interventions for patients with early-onset type 2 diabetes (EOT2D). By focusing on adults with EOT2D, she seeks to address the comparatively poor micro- and macrovascular outcomes in this population that may result partly from inadequate management of hyperglycemia and other cardiovascular disease risk factors. Dr. Gopalan’s research premise posits that it is particularly critical for newly diagnosed patients with EOT2D to achieve early disease control, since tighter glycemic control during the year following diagnosis confers long-lasting micro- and macrovascular benefits. In support of the premise, the Research Aims of this K23 are to: 1) use electronic health record [EHR] data to identify EOT2D patient subgroups at highest risk of inadequate early disease control, 2) identify barriers to and facilitators of initial EOT2D management, and 3) examine prospective associations between patient-reported factors (e.g., disease-related distress, health literacy) and inadequate early disease control. The proposed research will be supported by experienced mentors and advisors, as well as advanced training in the following areas: 1) the use of advanced statistical modeling, 2) qualitative data analysis to inform intervention development, 3) the role of social determinants in health, and 4) implementation science. KPNC and DOR are ideal environments for the proposed work. KPNC is an integrated learning healthcare delivery system with a diverse membership of 4.2 million people (>350,000 with diabetes). DOR has a long track record of effectively training early stage investigators and has well-established internal research programs and collaborative relationships with nearby institutions that provide the infrastructure needed for career development. This environment, along with the proposed Research and Training Plans and an outstanding mentorship team, will enable Dr. Gopalan to continue to build the skills and generate the foundational data needed to submit an R01-level proposal during the final years of the proposed award period. In this planned R01, Dr. Gopalan will refine and implement an intervention (with a design based on the results of the three K23 Research Aims) to improve early care for newly diagnosed EOT2D patients and evaluate its impact on early outcomes in this growing, high-risk population. In summary, the proposed K23 award will support the career development of Dr. Gopalan and is vital to her acquiring the skill set and expertise required to become a successful, independent investigator.