Type 2 diabetes mellitus is a substantial health care burden for individuals over 65 but little clinical research has been specifically devoted to establishing preventive care guidelines for this population. Preventive care goals need to be individualized for older patients, a process that requires accounting for all treatment effects, patient heterogeneity, and individual preferences. I am a general internist who seeks to develop a career at the intersection of diabetes and geriatrics that is focused on the evaluation and individualization of diabetes care goals for older patients, using a decision modeling approach. In four years, I would like to be able to conduct a series of decision-analytic studies using available trial and epidemiological data that illustrate how patient heterogeneity and preferences should influence the setting and prioritization of prevention goals such as the control of blood glucose, blood pressure, and serum cholesterol. In order to reach this long-term goal, I will obtain additional research training and experience in multiple disciplines through formal coursework, one-on-one mentoring, and completion of a series of modeling projects and a patient survey over the next four years. The faculty and resources of the University of Chicago make it a rich environment for career development in aging-related research. This research plan is composed of four specific aims: 1) To develop a model of type 2 diabetes designed to analyze the effectiveness and cost-effectiveness of varying levels of glucose control for subjects over the age of 65; 2) To evaluate the impact of patient heterogeneity on the effectiveness and cost-effectiveness of varying levels of glucose control for older subjects; 3) To assess older patients' preferences regarding life with diabetes treatments and complications and to evaluate the effect of preferences on the effectiveness and cost-effectiveness of glucose control strategies; 4) To begin to evaluate the effectiveness and cost-effectiveness of non-glycemic control related treatments in older subjects. Optimizing the individualization of comprehensive diabetes care has the potential to dramatically reduce complications and improve quality of life for older patients. The development and evaluation of a glucose control module and the collection of patient preference data will be crucial to future decision-analytic studies of comprehensive diabetes care in older patients. Along with more research training, these studies will also help me reach my overall goal of becoming an independent investigator in the areas of geriatric diabetes and cost-effectiveness analysis.
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