? Recent trials demonstrating the benefits of intensive glycemic control in the ICU setting have focused attention on glycemic control during non-ICU hospitalizations. Achieving tight glycemic control in inpatient general medical or surgical wards is not yet supported by data; its pursuit is resource-intensive and may be risky. Independent of the acute benefits of inpatient diabetes management, hospitalization offers an opportunity to improve care after discharge for the 25% of all patients with diabetes who are hospitalized annually. The candidate's career goal is to become an independent clinical researcher in diabetes with a focus on translating evidence-based guidelines into effective diabetes care. In this proposal the candidate will learn to apply rigorous epidemiologic, biostatistical, and clinical trial research methods to the problems of inpatient diabetes management and the transition from inpatient to outpatient care. The proposed studies will establish the preliminary data for larger trials to improve inpatient diabetes care and to use the hospital admission as an opportunity to optimize overall care in these patients.
Specific Aim 1 : To examine risk factors for and management of hyper- and hypoglycemia among a large cohort of general inpatients with diabetes (Type 1 or Type 2) and to examine the relationship of inpatient diabetes care to glycemic control after discharge.
Specific Aim 2 : To determine the true prevalence of hyper- and hypoglycemia in inpatients with diabetes using continuous glucose monitoring (CGM) and to establish an evidence-based standard for frequency of monitoring and reporting of inpatient glycemia.
Specific Aim 3 : To perform a randomized controlled trial in hospitalized patients with poorly controlled diabetes comparing the impact of a strategy of inpatient medication titration, patient education, and facilitated outpatient transition vs. usual care on outpatient glycemic control 6 months after discharge. This career development award will help the candidate to acquire additional research skills and experience under the mentorship of internationally known researchers in a supportive academic environment and will allow her to achieve her goal of becoming an independent patient-oriented researcher in diabetes 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 #
1K23DK080228-01
Application #
7360714
Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Hyde, James F
Project Start
2007-09-20
Project End
2012-08-31
Budget Start
2007-09-20
Budget End
2008-08-31
Support Year
1
Fiscal Year
2007
Total Cost
$135,140
Indirect Cost
Name
Massachusetts General Hospital
Department
Type
DUNS #
073130411
City
Boston
State
MA
Country
United States
Zip Code
02199
Wei, Nancy J; Nathan, David M; Wexler, Deborah J (2015) Glycemic control after hospital discharge in insulin-treated type 2 diabetes: a randomized pilot study of daily remote glucose monitoring. Endocr Pract 21:115-21
Safren, Steven A; Gonzalez, Jeffrey S; Wexler, Deborah J et al. (2014) A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in patients with uncontrolled type 2 diabetes. Diabetes Care 37:625-33
Lim, Soo; Kim, Kyoung Min; Kim, Min Joo et al. (2013) The association of maximum body weight on the development of type 2 diabetes and microvascular complications: MAXWEL study. PLoS One 8:e80525
Wei, N J; Wexler, D J; Nathan, D M et al. (2013) Intensification of diabetes medication and risk for 30-day readmission. Diabet Med 30:e56-62
Gonzalez, Jeffrey S; Schneider, Havah E; Wexler, Deborah J et al. (2013) Validity of medication adherence self-reports in adults with type 2 diabetes. Diabetes Care 36:831-7
Beauharnais, Catherine C; Roberts, Drucilla J; Wexler, Deborah J (2012) High rate of placental infarcts in type 2 compared with type 1 diabetes. J Clin Endocrinol Metab 97:E1160-4
Wei, Nancy J; Wexler, Deborah J (2012) Basal-bolus insulin protocols enter the computer age. Curr Diab Rep 12:119-26
Wei, Nancy J; Wexler, Deborah J (2012) Perioperative Glucose Management. Hosp Med Clin 1:e508-e519
Beauharnais, Catherine C; Larkin, Mary E; Zai, Adrian H et al. (2012) Efficacy and cost-effectiveness of an automated screening algorithm in an inpatient clinical trial. Clin Trials 9:198-203
Wexler, Deborah J; Beauharnais, Catherine C; Regan, Susan et al. (2012) Impact of inpatient diabetes management, education, and improved discharge transition on glycemic control 12 months after discharge. Diabetes Res Clin Pract 98:249-56

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