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.
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