News & Research

    Northwestern University, Chicago, Illinois

A Study to Evaluate Glycemic Control on Outcomes Following Liver Transplantation

General Research Subject: Type 2 Diabetes

Focus: Clinical Therapeutics/New Technology\Pharmacologic Treatment of Diabetes or its Complications, Health Care Delivery/Economics, Transplantation

Type of Grant: Junior Faculty

Project Start Date: January 1, 2013

Project End Date: December 31, 2015

Research Description

As obesity and diabetes overwhelm the population, their effects on other disease processes need to be elucidated. Liver transplant is the second largest organ transplant group nationwide and there are data to suggest that hyperglycemia (elevated glucose levels) in those with and without diabetes causes harmful effects on the transplanted liver graft function and increases morbidity and poor clinical outcomes. The goal of this research is to examine the effects of insulin therapy for hyperglycemia on persons undergoing liver transplantation in the hospital setting to assess the efficacy and safety of such practices.

An additional goal is to further examine, by direct in-person feedback by both patient and clinical providers, any possible barriers and vulnerabilities in the systems and processes of diabetes care, in order to identify and manage hyperglycemia in the transitions of care following the surgery. Such transitions of care include moving from intensive care unit (ICU) to the regular hospital floor and discharge planning for outpatient care, and continued inpatient to outpatient care following surgery. This study will help directly evaluate the possible benefits and risks of treating hyperglycemia in the hospital setting while giving us valuable information that will allow identification of opportunities for improvement in the care of these patients who are at high risk for diabetes.

This research can potentially benefit all patients who are at high risk for diabetes or high blood glucose levels following surgery by examining care in the inpatient setting and assessing quality and safety in transitional care settings.

Research Profile

What area of diabetes research does your project cover? What role will this particular project play in preventing, treating, and curing diabetes?

As obesity and diabetes overwhelm the population, their effects on other disease processes need to be elucidated. Liver transplant is the second largest organ transplant group nationwide and there are data to suggest that hyperglycemia (elevated glucose levels) in those with and without diabetes causes harmful effects on transplanted liver graft function and increases morbidity and poor clinical outcomes. The goal of this research is to examine the effects of insulin therapy for hyperglycemia on persons undergoing liver transplantation in the hospital setting to assess the efficacy and safety of such practices.

In addition the goal is to further examine, by direct in person feedback of both patient and clinical providers, the possible barriers and vulnerabilities in the systems and processes of care, in identification and management of hyperglycemia in the transitions of care following the surgery. This will help directly evaluate the possible benefits of treating glucose control in the hospital setting while giving us valuable information to identify possible opportunities for improvement in the care of these patients who are at high risk for diabetes.

This research can potentially benefit all patients who are at high risk for diabetes or high blood sugar levels following surgery, or pregnancy or other high risk times, by examining care in the inpatient setting and assessing quality and safety in between care settings and between inpatient and outpatient settings.

If a person with diabetes were to ask you how your project will help them in the future, how would you respond?

This project will help both clinical providers and patients understand the barriers in care and potential opportunities for improvement in the identification and management of high blood sugar levels in the transitional care setting. Following a solid organ transplant, patients have multiple providers including new transplant physicians, specialty physicians, and primary care physicians, and sometime receive care in multiple settings (both in and out of the hospital).

This project will help evaluate the use of insulin on high blood sugar levels directly following transplant in the hospital, to see if the use of insulin could improve patient outcomes long term. In addition, it will give us valuable information about the quality of identification and management of diabetes and the safety of medication use, in this highly transitional setting.

Why is it important for you, personally, to become involved in diabetes research? What role will this award play in your efforts?

Personally, I have been involved as an investigator in clinical trials work for some time, and also serve as a physician for several patient with diabetes and for those who are high risk for diabetes. Through my clinical work, I have realized that in real life, patients may receive care (such as intensive insulin management) in the hospital setting, which may need to be continued outside the hospital, but often have trouble re-establishing care for a multitude of reasons. I have seen patients become frustrated with their diabetes care specifically, when there are many providers and locations involved, especially when it comes to medication management.

Through my clinical trials work, I have realized that the results seen in such trials, may have trouble being replicated in the real life clinical setting. This award will allow me to continue my group's research, specifically a clinical trial in the hospital setting examining intensive insulin management following liver transplant for improved transplant outcomes. In addition, it will allow me to gather important patient-centered data on the opportunities for improved care in identification and management of diabetes, following their transplant, based on direct feedback from providers and patients.

In what direction do you see the future of diabetes research going?