Rationale: Diabetes mellitus (DM) is becoming increasingly common in the nursing home (NH) population. However, there is great uncertainty about the optimal level of glycemic control for NH residents with DM. Our broad objective is to develop an evidence base to individualize and improve the care for NH residents with DM.
Research Aims :
Our aims are to (1) determine the current practices for blood sugar control in a national sample of veterans affairs (VA) NHs, (2) determine whether the level of glycemic control is associated with geriatric outcomes such as incontinence and falls and (3) explore the goals of treatment and preferences of individual NH residents regarding treatments (e.g. insulin) and outcomes. Career Objectives/Aims: These projects will allow the PI to develop expertise (1) using electronic medical record data for clinical research and (2) performing qualitative research eliciting patient values and preferences. Research Design/Methods:
For Aims 1 and 2, we will obtain laboratory, pharmacy and outcomes data for all VA NHs. We will determine current practices by determining the proportion of VA NH residents with diabetes who are getting specific treatments (e.g. insulin or oral medications) and direct complications (e.g. hypoglycemia). We will then determine whether complications and geriatric outcomes are associated with HbA1c levels, stratified by treatment.
For Aim 3, we will conduct semi-structured interviews with residents of the San Francisco VA NH and the Jewish Home of San Francisco to elicit their values and preferences regarding DM treatments and outcomes. Relevance to Public Health: By determining the current practices and the relationship between the level of blood sugar control and geriatric outcomes such as incontinence, we will provide information for patients and clinicians so that they can make individualized decisions about diabetes care in the NH. Further, by highlighting relationships and common patient preferences, our work will obtain data to support future studies implementing tools to promote individualized decision making for NH residents with diabetes.

Public Health Relevance

By determining the current practices and the relationship between the level of blood sugar control and geriatric outcomes such as incontinence, we will provide information for patients and clinicians so that they can make individualized decisions about diabetes care in the NH. Further, by highlighting relationships and common patient preferences, our work will obtain data to support future studies implementing tools to promote individualized decision making for NH residents with diabetes.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23AG040779-02
Application #
8325443
Study Section
Special Emphasis Panel (ZAG1-ZIJ-6 (M2))
Program Officer
Salive, Marcel
Project Start
2011-09-01
Project End
2014-08-31
Budget Start
2012-09-01
Budget End
2013-08-31
Support Year
2
Fiscal Year
2012
Total Cost
$183,358
Indirect Cost
$13,582
Name
University of California San Francisco
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
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