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.
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.
|Hsu, Amy; Gan, Siqi; Cenzer-Stijacic, Irena et al. (2017) Glycemic Control and Functional Decline in Nursing Home Residents With Diabetes. JAMA Intern Med 177:130-132|
|Kobayashi, Lindsay C; Jackson, Sarah E; Lee, Sei J et al. (2017) The development and validation of an index to predict 10-year mortality risk in a longitudinal cohort of older English adults. Age Ageing 46:427-432|
|Lipska, Kasia J; Krumholz, Harlan; Soones, Tacara et al. (2016) Polypharmacy in the Aging Patient: A Review of Glycemic Control in Older Adults With Type 2 Diabetes. JAMA 315:1034-45|
|Barnhart, Caroline; McClymont, Keelan; Smith, Alex K et al. (2016) ""Everyone else gets ice cream here more often than I do--It burns me up""--Perspectives on Diabetes Care from Nursing Home Residents and their Doctors. BMC Geriatr 16:28|
|Chodos, Anna H; Lee, Sei J (2015) Journalists, district attorneys and researchers: why IRBs should get in the middle. BMC Med Ethics 16:19|
|Tang, Victoria; Boscardin, W John; Stijacic-Cenzer, Irena et al. (2015) Time to benefit for colorectal cancer screening: survival meta-analysis of flexible sigmoidoscopy trials. BMJ 350:h1662|
|Hsu, Amy; Nakagawa, Sanae; Walter, Louise C et al. (2015) The burden of nocturia among middle-aged and older women. Obstet Gynecol 125:35-43|
|Lee, Sei J; Stijacic-Cenzer, Irena; Barnhart, Caroline et al. (2015) Changing Patterns of Glucose-Lowering Medication Use in VA Nursing Home Residents With Diabetes, 2005 to 2011. J Am Med Dir Assoc 16:898.e9-14|
|Lee, Sei J (2014) So much insulin, so much hypoglycemia. JAMA Intern Med 174:686-8|
|Lee, Sei J; Boscardin, W John; Kirby, Katharine A et al. (2014) Individualizing life expectancy estimates for older adults using the Gompertz Law of Human Mortality. PLoS One 9:e108540|
Showing the most recent 10 out of 27 publications