Differences Among Older English and Spanish-speaking Latinx Patients with Type 2 Diabetes at Risk for Hypoglycemia (Admin Supp)

项目摘要 许多患有2型糖尿病（T2 D）的老年人由于密集的T2 D而经历危险的低血糖 药物治疗。1，2降低治疗强度的决定必须根据患者的偏好 3教育患者并培养他们表达偏好的沟通技能的新工具 为提高高危老年人T2 D护理的安全性提供了一种有前景的策略。4，5本R 01的目标 奖项是应用价值观启发和沟通和决策技能建设的原则， 低血糖相关的不良后果在脆弱的老年患者的具体临床问题。的目的 母公司R 01将开发一种在线工具，专门解决老年人T2 D治疗强度， 增加低血糖事件的风险，然后进行随机试验，以评估这种治疗的疗效。 减少75岁以上高危患者低血糖事件的新工具。我们的支持方式 价值取向的护理是一种创新的和潜在的广泛适用的方法，以帮助老年人 根据他们的目标和偏好做出明智的决定。6如果成功，这个框架可以扩展 并应用于各种医疗保健环境和慢性疾病，其中不断变化的风险，益处和 治疗的结果需要随着年龄的增长而重新评估。克拉丽莎·弗格森的加入 行政补充将为该项目提供一个极好的机会， 西班牙裔/拉丁裔受试者，否则有资格参加我们的临床试验（约29%的 预期的参与者，与北方加州的源人口比例相似）。 老年西班牙裔/拉丁裔2型糖尿病患者与成年人的相似性和独特差异 来自其他种族/民族的人参与医疗保健系统及其当前的药物相关实践。 针对老年西班牙裔/拉丁裔患者的进一步研究有可能为如何 最好让这一患者群体参与旨在提高参与度和降低药物风险的研究。8 拟议的研究与父母补助金的主要目标直接相关，同时也拓宽了我们的研究领域。 通过扩展我们对西班牙裔/拉丁裔患者的比较分析。这项研究涉及三个NIH 将证据转化为实践，提高药物安全性和了解医疗保健的优先事项 差距。在代表不足的少数群体行政委员会内提出的具体项目 补充将侧重于老年西班牙裔/拉丁裔2型糖尿病患者的检查， 低血糖风险。这项补充工作将进一步深入了解潜在的差距， 老年西班牙裔/拉丁裔患者在初级保健访视期间面临的独特沟通障碍。

Project Summary Many older adults with type 2 diabetes (T2D) experience dangerous hypoglycemic due to intensive T2D medication treatment.1,2 The decision to reduce treatment intensity must be informed by patient preferences and values.3 New tools that educate patients and build their communication skills to voice their preferences offer a promising strategy for improving the safety of T2D care in high-risk older adults.4,5 The goal of this R01 award is to apply principles of values elicitation and skill building for communication and decision making to the specific clinical problem of hypoglycemia-related adverse outcomes in vulnerable older patients. The aims of the parent R01 are to develop an online tool to specifically address T2D treatment intensity in older adults at increased risk for hypoglycemic events, and to then conduct a randomized trial to assess the efficacy of this new tool to reduce hypoglycemia events among high-risk patients 75 years of age. Our approach to support value-aligned care represents an innovative and potentially widely applicable method to help older adults to make informed decisions based on their goals and preferences.6 If successful, this framework could be scaled and applied in a wide variety of healthcare settings and chronic conditions in which evolving risks, benefits, and consequences of treatment require re-assessment with age. The addition of Clarissa Ferguson through this Administrative Supplement will provide the project with the excellent opportunity to conduct analyses of older Hispanic/Latinx participants who would otherwise be eligible for our clinical trial (approximately 29% of expected participants, similar proportion to the source population in Northern California).7 She will examine the similarities and unique differences in how older Hispanic/Latinx patients with type 2 diabetes versus adults from other race/ethnicities engage with the health care system and their current medication-related practices. Further study focused on older Hispanic/Latinx patients has the potential to provide useful insight into how to best engage this patient population in research designed to improve engagement and reduce medication risk.8 The proposed research is directly related to the main goals of the parent grant while also broadening our project by extending our comparative analyses of Hispanic/Latinx patients. This study addresses the three NIH priorities of translating evidence into practice, improving medication safety, and understanding health care disparities. The specific project proposed within the Under-Represented Minority (URM) Administrative Supplement will focus on the examination of older Hispanic/Latinx patients with type 2 diabetes at increased risk for hypoglycemia. This supplemental work will provide further insight into the potential disparities and unique barriers to communication faced by older Hispanic/Latinx patients during primary care visits.