_I_TH_______________________ Nestoras Mathioudakis, MD MHS, is an Assistant Professor in the Division of Endocrinology, Diabetes, and Metabolism at Johns Hopkins University. Dr. Mathioudakis seeks a Mentored Patient-Oriented Research Career Development Award in order to obtain the skills, knowledge, and mentored research experience that are essential for a career as a clinician scientist in the field of inpatient glycemic management. This proposal is aimed at reducing preventable harm due to hypoglycemia from insulin treatment among hospitalized patients. Insulin accounts for the vast majority of hypoglycemic events among hospitalized patients, prompting the Joint Commission and the Institute for Safe Medication Practices to designate it a ?high alert? medication. In fact, glucose-lowering medications rank first among drugs with the highest rates of adverse events in the hospital. A common cause of insulin-associated hypoglycemia is ?therapeutic inertia??failure to reduce or modify insulin in patients with downward trending blood glucose. The objectives of this proposal are to apply the safety management principles from high reliability organizations, such as commercial aviation, to reduce preventable harm from insulin-associated hypoglycemia in non-critically ill hospitalized patients.
The specific aims of this research proposal are to: 1) develop a prediction model for insulin-associated hypoglycemia, 2) develop a real-time informatics alert, using stakeholder engagement and based on clinical practice guidelines, for patients at risk of incident insulin-associated hypoglycemia, and 3) evaluate the effectiveness of a real-time informatics alert in prevention insulin-associated hypoglycemia.
For Aim 1, we propose a retrospective study using a large hospital dataset containing clinical, pharmacological, and laboratory data to develop and validate a prediction model for insulin-associated hypoglycemia.
For Aim 2, we propose a prospective observational study using qualitative research methods to develop the real-time informatics alerts based on key stakeholder input.
For Aim 3, we propose an interrupted time-series (before/after) study design to evaluate whether a real-time informatics alert reduces the incidence of insulin-associated hypoglycemia over a 12-month time period. The goals during the award period include developing expertise in the design, performance, analysis and presentation of clinical research through mentored research, didactic coursework, and formal training in healthcare analytics. Long-term career goals include developing a career as an independent investigator examining health information technology (IT) strategies to improve glycemic control among hospitalized and ambulatory populations with diabetes. The proposed research aims to provide new insights into the development process of informatics alerts and their effectiveness in preventing insulin-associated hypoglycemia in the hospital, which is associated with poor clinical outcomes for patients. This work will lay the foundation for future research to evaluate the role of health IT in targeting glycemic outcomes in both hospitalized and ambulatory patients with diabetes.

Public Health Relevance

I_TH_______________________ Hypoglycemia resulting from insulin treatment in the hospital is common and has been linked to poor patient outcomes and even death. The proposed research aims to investigate whether a real-time alert in the electronic medical record can prevent hypoglycemia due to insulin treatment among hospitalized patients. This work will inform efforts to develop and implement health informatics strategies to improve the quality and safety of blood glucose control for the nearly one in four hospitalized patients with diabetes in the United States.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Mentored Patient-Oriented Research Career Development Award (K23)
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Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK-B)
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Spain, Lisa M
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Johns Hopkins University
Internal Medicine/Medicine
Schools of Medicine
United States
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Mathioudakis, Nestoras Nicolas; Everett, Estelle; Routh, Shuvodra et al. (2018) Development and validation of a prediction model for insulin-associated hypoglycemia in non-critically ill hospitalized adults. BMJ Open Diabetes Res Care 6:e000499
Golden, Sherita Hill; Maruthur, Nisa; Mathioudakis, Nestoras et al. (2017) The Case for Diabetes Population Health Improvement: Evidence-Based Programming for Population Outcomes in Diabetes. Curr Diab Rep 17:51
Khan, Saira; Golden, Sherita Hill; Mathioudakis, Nestoras (2017) Associations between home insulin dose adjustments and glycemic outcomes at hospital admission. Diabetes Res Clin Pract 127:51-58