Predicting the Risk of Severe Hypoglycemic and Hyperglycemic Events in Adults with Diabetes

项目摘要/摘要 麦考伊医生是一名内分泌学家和初级保健医生，专门从事糖尿病患者的护理和 其他慢性健康状况。她的长期目标是成为一名独立的研究人员和评估领域的领导者， 通过有效使用大数据来改善糖尿病护理并使其个性化，这些大数据来自 病人和那些参与他们护理的人。这项建议的短期培训目标是：1)熟练掌握 统计学和数据科学；2)定性研究经验；3)临床试验设计技能；4) 具有领导多学科研究的沟通和领导能力。将对该提案进行研究 在梅奥诊所，该诊所拥有培训内科科学家的强大历史和完善的基础设施 教育和研究。McCoy博士可以访问一组理想的数据资产，即OpumLabs数据仓库和 Kaiser Permanente North California糖尿病注册中心，以及一支杰出的导师团队和 在糖尿病后果和医疗保健提供研究方面处于国家领先地位的顾问，分享决策， 定性研究和数据科学。 优化血糖控制，同时避免严重低血糖和高血糖，是 糖尿病管理。严重的低血糖和高血糖通常是可以预防的，但仍会继续引起 严重的发病率、心理困扰、生活质量受损和经济负担。没有经过验证的 预测这些事件的工具，因此临床医生缺乏实用和可靠的手段来识别高风险 病人。麦考伊博士的工作目标是解决糖尿病管理中的这一关键差距。在《目标1》中，她将使用 大型数据库分析和新的分析方法，以表征严重低血糖和 在Aim 2中，她将在Aim 1的基础上开发和验证 计算高效的严重低血糖和高血糖并发风险预测模型 可用于临床治疗。在目标3中，她将直接与患者及其临床医生进行对话，讨论 严重低血糖/高血糖风险，以便更好地了解有关严重低血糖/ 高血糖风险被感知、解释和利用。这些研究将作为两个R01的基础 将在第4年和第5年提交申请，并将推动个性化糖尿病的科学和实践 通过数据科学和定性方法的集成进行护理，以了解、预测和 最终预防严重的低血糖/高血糖事件。麦考伊博士在科学研究方面有着良好的记录 生产力和创新，以及在使用卫生服务和结果的辅助数据方面的坚实基础 糖尿病方面的研究。总之，这里提出的培训、指导和研究对麦考伊博士的 随着她在患者之间的关键接口上发展研究独立性和专业知识，她的职业发展 以及他们的临床团队、循证医学和大数据。

PROJECT SUMMARY/ABSTRACT Dr. McCoy is an endocrinologist and primary care physician specializing in the care for patients with diabetes and other chronic health conditions. Her long-term goal is to become an independent researcher and leader in evaluating, improving, and individualizing diabetes care through effective use of big data completed by qualitative insights from patients and those involved in their care. The short-term training goals of this proposal are to acquire: 1) proficiency in statistics and data science; 2) experience in qualitative research; 3) skills in clinical trial design; and 4) communication and leadership skills to lead multi-disciplinary research. The proposal's research will be conducted at Mayo Clinic, which has a strong history of training physician scientists and a well-developed infrastructure for education and research. Dr. McCoy has access to an ideal set of data assets, the OptumLabs Data Warehouse and the Kaiser Permanente Northern California Diabetes Registry, and the support of an exceptional team of mentors and advisors who are national leaders in diabetes outcomes and health care delivery research, shared decision-making, qualitative research, and data science. Optimization of glycemic control, while avoiding severe hypoglycemia and hyperglycemia, is the cornerstone of diabetes management. Severe hypoglycemia and hyperglycemia are often preventable, yet continue to incur substantial morbidity, psychological distress, impaired quality of life, and economic burden. There are no validated tools to predict these events and as a result clinicians lack a practical and reliable means to identify high risk patients. The goal of Dr. McCoy's work is to address this critical gap in diabetes management. In Aim 1, she will use large database analysis and novel analytic methods to characterize the patterns of severe hypoglycemia and hyperglycemia among adults with diabetes in the U.S. In Aim 2, she will build on Aim 1 to develop and validate computationally efficient concurrent risk prediction models for severe hypoglycemia and hyperglycemia that could be used in clinical encounters. In Aim 3, she will directly engage patients and their clinicians in conversation about severe hypoglycemia /hyperglycemia risk in order to better understand how information about severe hypoglycemia/ hyperglycemia risk is perceived, interpreted, and used. These studies will serve as foundation for two R01 applications to be submitted during Years 4 and 5, and will advance the science and practice of personalized diabetes care through integration of data science and qualitative methods for the purpose of understanding, predicting, and ultimately preventing severe hypoglycemic/hyperglycemic events. Dr. McCoy has a proven track record of scientific productivity and innovation, and a strong foundation in using secondary data for health services and outcomes research in diabetes. In summary, the training, mentoring, and research proposed here are essential for Dr. McCoy's career development as she develops research independence and expertise in the crucial interface between patients and their clinical teams, evidence-based medicine, and big data.