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

项目摘要 博士Anjali Gopalan，医学博士，MSHP是北方加州凯撒医疗机构的董事会认证内科医生 （KPNC）奥克兰医学中心和KPNC的研究科学家I（相当于助理教授） 研究部（DOR）。通过拟议的K23指导职业发展奖，Gopalan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， 并为早发2型糖尿病（EOT 2D）患者实施量身定制的干预措施。通过关注 对于患有EOT 2D的成年人，她试图解决这种相对较差的微血管和大血管结局， 部分原因可能是高血糖和其他心血管疾病管理不当 疾病风险因素。Gopalan博士的研究前提假定，对于新诊断的 EOT 2D患者实现早期疾病控制，因为在随后一年内血糖控制更严格 诊断赋予长期持久的微血管和大血管益处。为了支持这一假设，研究 本K23的目的是：1）使用电子健康记录[EHR]数据识别EOT 2D患者亚组， 早期疾病控制不充分的风险最高，2）确定初始EOT 2D的障碍和促进因素 管理，以及3）检查患者报告的因素之间的前瞻性关联（例如，疾病相关 不幸，健康知识）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，以及在以下领域的高级培训：1）使用先进的 统计建模，2）定性数据分析，为干预措施的制定提供信息，3）社会的作用 健康的决定因素; 4）实施科学。KPNC和DOR是 提议的工作。KPNC是一个综合性的学习医疗保健提供系统，拥有4.2个不同的成员 100万人（> 35万糖尿病患者）。DOR在早期有效培训方面有着悠久的历史 研究人员，并有完善的内部研究计划和合作关系，与附近的 提供职业发展所需基础设施的机构。这种环境，沿着 拟议的研究和培训计划以及优秀的导师团队，将使Gopalan博士能够 继续培养技能并生成提交R 01级提案所需的基础数据， 建议授标期的最后几年。在这个计划的R 01中，Gopalan博士将完善和实施一个 干预（基于三个K23研究目标的结果设计），以改善早期护理， 新诊断的EOT 2D患者，并评估其对这一日益增长的高风险 人口总之，拟议的K23奖将支持Gopalan博士的职业发展， 这对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.