Hypoglycemia is the most common adverse effect of diabetes treatment. Severe hypoglycemia is more frequent in older adults than their younger counterparts and is associated with increased risk of falls, fractures, dementia, cardiovascular events, mortality, and poor quality of life. Diabetes care quality metrics focus almost exclusively on prevention of hyperglycemia and its complications and reward target-based glucose lowering - this can potentially lead to one-size-fits-all clinical practice and an increase in adverse event. Recent clinical guidelines call for individualized goal-setting in diabetes care, but data on how t personalize care to maximize benefits and minimize adverse events are lacking. A clear and comprehensive understanding of the burden of hypoglycemia on patients and a rigorous examination of risk factors for hypoglycemia are required to inform treatment decisions in older persons with diabetes, assess an important aspect of current quality of care, and provide future targets for intervention that may mitigate the burden of hypoglycemia. The candidate's career goal is to become an independent clinical investigator in the field of diabetes and geriatrics, generating knowledge to help guide personalized diabetes treatment. In this proposal, the candidate will apply rigorous epidemiologic, biostatistical, and qualitative research methods to evaluate older patients who experience severe hypoglycemia, identify potential contributors to hypoglycemia admissions, and examine the relationship between specific glucose targets, glucose-lowering therapies and hypoglycemic events in order to provide better information on treatment-related adverse events and improve clinical outcomes.
Specific Aim 1 : To characterize recent trends in hospital admissions for hypoglycemia among older Medicare recipients with diabetes for a 12-year period from 1998-2010, and to examine race, gender, and geographic differences in these trends.
Specific Aim 2 : To elucidate factors that may contribute to the risk of hospitalization for hypoglycemia among a sample of older adults with diabetes using qualitative methods.
Specific Aim 3 : To evaluate the association between glycemic control, glucose-lowering agents, and hypoglycemic events in the Diabetes Study of Northern California (DISTANCE), a multiethnic cohort of 20,000 patients with diabetes in a large integrated healthcare delivery system. The combination of a large scale surveillance approach, primary data collection to investigate potential reasons for hypoglycemia hospital admissions, and a detailed analysis of a clinical registry will provide the candidate with additional skills in large database analyses, qualitative research methods, and epidemiologic aging research - and will lead to future work to comprehensively understand the balance of risks and benefits of glucose-lowering therapy in older adults.

Public Health Relevance

Our research goal is to examine hypoglycemia in older adults, the most common adverse effect of diabetes therapy. Our proposed studies will help provide better information to patients and providers about the risk of hypoglycemia and identify potential ways this risk can be mitigated.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Small Research Grants (R03)
Project #
1R03AG045086-01
Application #
8555728
Study Section
Special Emphasis Panel (ZAG1-ZIJ-9 (M1))
Program Officer
Salive, Marcel
Project Start
2013-08-15
Project End
2015-07-31
Budget Start
2013-08-15
Budget End
2014-07-31
Support Year
1
Fiscal Year
2013
Total Cost
$83,250
Indirect Cost
$33,250
Name
Yale University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
043207562
City
New Haven
State
CT
Country
United States
Zip Code
06520
Lipska, Kasia J; Krumholz, Harlan M (2014) Comparing diabetes medications: where do we set the bar? JAMA Intern Med 174:317-8
Gionfriddo, Michael R; McCoy, Rozalina G; Lipska, Kasia J (2014) The 2013 American Association of Clinical Endocrinologists' diabetes mellitus management recommendations: improvements needed. JAMA Intern Med 174:179-80
Lipska, Kasia J; Ross, Joseph S; Wang, Yun et al. (2014) National trends in US hospital admissions for hyperglycemia and hypoglycemia among Medicare beneficiaries, 1999 to 2011. JAMA Intern Med 174:1116-24
Lipska, Kasia J; Ross, Joseph S; Van Houten, Holly K et al. (2014) Use and out-of-pocket costs of insulin for type 2 diabetes mellitus from 2000 through 2010. JAMA 311:2331-3