Observational follow-up of the landmark United Kingdom Prospective Diabetes Study revealed that early tight glycemic control had persistent benefits among adults with newly diagnosed diabetes even a decade after the trial had ended. This phenomenon has been dubbed the """"""""legacy effect"""""""" of glycemic control and has not been observed for blood pressure control. The existence of the legacy effect implies that the timing of glycemic control, for example, early vs. late in the disease course, may have clinical consequences. This raises new fundamental diabetes translational research questions. In clinical practice, how soon after diagnosis do patients achieve hemoglobin A1C (A1C) and blood pressure (BP) control and for how long? How do different long-term patterns of control affect future health outcomes? And what do patients believe regarding how and when the timing of therapies to achieve A1C and BP control affects their health outcomes? I am an internist who is committed to exploring whether the legacy effect exists in clinical practice and how to translate this novel observation from clinical trials into improved clinical care. Using a large, observationl cohort of adults from Kaiser Permanente Northern California with newly diagnosed diabetes (1995-2005), I will (Aim 1) characterize common patterns of a) A1C and b) BP control over e10 years of follow-up and (Aim 2) compare complications/mortality rates over e15 years of follow-up among patients with various 10-year patterns of a) A1C and b) BP control. Then in order to develop a theoretical model for how patients perceive the concept of time in their diabetes-related health decisions, I will conduct semi-structured interviews with patients with Type 2 diabetes to (Aim 3) explore their beliefs regarding the timing of A1C and BP control. The results of these studies will be used to inform a future R01 behavioral intervention focused on improving patient outcomes through effective risk communication and appropriately timed efforts to intensify A1C and BP control. During this career development award, I will work closely with my mentor, Dr. Elbert Huang, who is a nationally- recognized investigator in medical decision making for older adults with diabetes and Director of the Quantitative Analysis Core and Enrichment Programs of the Chicago Center for Diabetes Translation Research (P30) at the University of Chicago, and my co-mentor, Dr. Andrew Karter, an accomplished diabetes epidemiologist at Kaiser Permanente Northern California Division of Research, in addition to my advisory panel of leaders in longitudinal data analysis, endocrinology, health economics and behavioral psychology. This proposed research, along with additional training in advanced epidemiology, biostatistics and behavioral psychology, and the expertise of my mentorship team will help me achieve my long-term goal of becoming an independent clinical investigator with expertise in the optimal timing of Type 2 diabetes treatments and its risk communication.

Public Health Relevance

Landmark diabetes trials have found that patients who achieved tight glycemic control early in their disease course have improved health outcomes long after the trial intervention had ended. No such legacy effect has been observed for blood pressure control. For the purposes of diabetes care translation, it is important to determine what long-term patterns of glycemic and blood pressure control are achieved in clinical practice, to establish whether a legacy effect exists in clinical practice, and to explore how these timing effects can be translated into improved patient care.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23DK097283-02
Application #
8538972
Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Hyde, James F
Project Start
2012-09-01
Project End
2017-06-30
Budget Start
2013-07-01
Budget End
2014-06-30
Support Year
2
Fiscal Year
2013
Total Cost
$176,083
Indirect Cost
$13,043
Name
University of Chicago
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
005421136
City
Chicago
State
IL
Country
United States
Zip Code
60637
Myerson, Rebecca; Laiteerapong, Neda (2016) The Affordable Care Act and Diabetes Diagnosis and Care: Exploring the Potential Impacts. Curr Diab Rep 16:27
Laiteerapong, Neda (2016) Many US adults with controlled type 2 diabetes receive frequent HbA1c testing and possible overtreatment. Evid Based Med 21:98
Tung, Elizabeth L; Baig, Arshiya A; Huang, Elbert S et al. (2016) Racial and Ethnic Disparities in Diabetes Screening Between Asian Americans and Other Adults: BRFSS 2012-2014. J Gen Intern Med :
Laiteerapong, Neda; Cifu, Adam S (2016) Screening for Prediabetes and Type 2 Diabetes Mellitus. JAMA 315:697-8
Genere, Natalia; Sargis, Robert M; Masi, Christopher M et al. (2016) Physician perspectives on de-intensifying diabetes medications. Medicine (Baltimore) 95:e5388
Jain, Rajesh K; Laiteerapong, Neda (2015) Strategies for improving cardiovascular health in women with diabetes mellitus: a review of the evidence. Curr Diab Rep 15:98
Laiteerapong, Neda; Fairchild, Paige C; Chou, Chia-Hung et al. (2015) Revisiting Disparities in Quality of Care Among US Adults With Diabetes in the Era of Individualized Care, NHANES 2007-2010. Med Care 53:25-31
Grant, Richard W; Huang, Elbert S; Wexler, Deborah J et al. (2015) Patients who self-monitor blood glucose and their unused testing results. Am J Manag Care 21:e119-29
Laiteerapong, Neda; Huang, Elbert S (2015) The pace of change in medical practice and health policy: collision or coexistence? J Gen Intern Med 30:848-52
Karter, Andrew J; Laiteerapong, Neda; Chin, Marshall H et al. (2015) Ethnic Differences in Geriatric Conditions and Diabetes Complications Among Older, Insured Adults With Diabetes: The Diabetes and Aging Study. J Aging Health 27:894-918

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