Ziemer, David , MD
Hypoglycemia investigation, intervention and prevention operation (HII-PO)
General Research Subject: Both Type 1 And Type 2 Diabetes
Focus: Complications, Complications\Hypoglycemia, Health Care Delivery/Economics, Health Care Delivery/Economics\Medical informatics in direct patient therapy
Type of Grant: ADA-Novo Nordisk Award in Hypoglycemia in Diabetes
Project Start Date: July 1, 2012
Project End Date: June 30, 2015
Hypoglycemia (low blood sugar) is a dangerous obstacle to controlling diabetes, a common, costly and deadly disease with an especially severe impact among African Americans. While it happens often, the frequency is unclear. Factors that could predict when hypoglycemia will happen are not clear either. The cost of hypoglycemia is not known. It is a problem that needs to be identified, treated, and prevented. Few reliable preventions have been tested.
The HII-PO Project (Hypoglycemia Investigation, Intervention and Prevention Operation) will survey electronic information from the hospital, ambulance service and state records to see how often hypoglycemia happens and why. The project will develop and test a computer kiosk that diabetes patients may use before their clinic visit to answer questions about their medications, and hypoglycemia experiences. The computer will "interview" the patient asking questions which will help the patient, the provider and the system to be better prepared to recognize, understand, treat, and prevent the individual patient's low blood sugar problems. The HII-PO computer uses a simple, one-finger, touch-screen method for accepting answers. Questions and information will be "read aloud" to the patient while the words are seen on the screen. The HII-PO computer will take the patient's information and combine it with information from other sources, consider all, then generate reports (some for patient, some for provider) to help address any low blood sugar problems — so that these may be addressed at today's visit.
What area of diabetes research does your project cover? What role will this particular project play in preventing, treating and/or curing diabetes?
Hypoglycemia is a dangerous obstacle to controlling diabetes, a common, costly and deadly disease with an especially severe impact among African Americans. Controlling diabetes decreases complications and costs but requires medication adherence. Hypoglycemia is a costly, major barrier to adherence that often limits care. While hypoglycemia seems to be common, incidence and risk factor estimates vary widely. Better estimates of the scope, causes and costs of hypoglycemia are needed to develop and prioritize prevention efforts. Moreover, hypoglycemia often goes undetected in part due to lack of provider time. Screening and risk identification must be improved and followed by interventions to prevent hypoglycemia. Few interventions have been tested. The optimal tool is an automated system that combines screening and intervention. Computer assisted self-interviews (CASI) and decision support can do both.
This project will improve treatment of diabetes by determining the frequency of and risk factors for hypoglycemia using medical records and the statewide reporting system data for hospitalizations and emergency room visits. It will further refine a computer assisted self-interview to improve screening for hypoglycemia. It will use individual patient information to produce alerts to and preventive suggestions for clinicians seeing that diabetes patients. These should decrease hypoglycemia.
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 produce a system to reduce the frequency of hypoglycemia. It will produce a list of risk factors that can be compared to an individuals own characteristics to improve awareness. It will also provide some management suggestions to decrease risk. This will improve safety for persons with diabetes.
Why is it important for you, personally, to become involved in diabetes research? What role will this award play in your research efforts?
Diabetes has an enormous individual and public health impact. There are many openings for management improvements to prevent complications and lessen the adverse impacts of diabetes. I work with a population that is more heavily burdened than most. They can be helped by harnessing health information technology (HIT) to change the system of healthcare delivery. HIT and altered work patterns can reduce the reliance on thousands of individual providers remembering to perform some actions from hundreds of possible interventions at each and every patient visit. I believe our team has strong skills from a wide array of disciplines to focus on questions and problems that will improve care for persons with diabetes. That will allow those persons to carry on their lives with fewer interruptions and limitations.
In what direction do you see the future of diabetes research going?
Policy makers will improve their recognition of the crippling impact of diabetes on healthcare costs, economic productivity and quality of life. Diabetes research will need more attention and funding, in general. Research into better methods of secondary prevention of complications and improved access and delivery of management will continue. The shift to primary prevention must become a high priority. That shift will require research in areas of not just personal behavior but also societal behaviors and policies and changes in the built environment and community planning. This will require recruitment collaborators from groups not traditionally involved with health – architects, city planners, politicians, educators, policy makers and even popular and electronic media.
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