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Predicting and Reducing Future Health Disparities for U.S. Adults with Diabetes

​The clinical and financial impact of diabetes-related interventions and policies may not be quantifiable without the use of simulation models that reflect the long-term course of disease and its complications. Models of diabetes complications are used by healthcare delivery systems and policymakers to calculate the cost-effectiveness of new tests, therapies, and policies. Most models are based on findings from the U.K. Prospective Diabetes Study, conducted in the 1980s and 1990s. These models often lack transparency and have not been updated to reflect contemporary treatments or course of diabetes, the ethnic diversity of the United States, or the importance of outcomes such as hypoglycemia. This project involves development and validation of a transparent, contemporary model of diabetes complications based on a multi-ethnic U.S. cohort (Kaiser Permanente Northern California members) that can be used by healthcare delivery systems and policymakers to guide decisions regarding optimal approaches to diabetes management.     
Investigator: Karter, Andrew
Funder: National Institute on Minority Health and Health Disparities

Severe Hypoglycemia: Ascertainment, Surveillance and Pharmacovigalence

Diabetes medications are commonly used to reduce high blood sugar, but their use can sometimes lead to dangerously low blood sugar. “Severe hypoglycemia” (SH), defined as low blood sugar for which the patient requires assistance, has emerged as one of the most prevalent complications of diabetes treatment and a critical public health concern. SH is associated with poor quality of life, serious falls, car accidents, arrhythmia, dementia, hospitalizations, and a greatly increased risk of death. It has been estimated that among older adults, one in four emergency hospitalizations for adverse drug events are due to SH. We will study SH in a large population of adults with type 2 diabetes, develop improved tools to identify SH and obtain a better understanding of risks associated with each diabetes drug, as well as their interactions with non-diabetic drugs.
Investigator: Karter, Andrew
Funder: National Institute of Diabetes and Digestive and Kidney Diseases

The Next Frontier in Diabetes Communication: Promoting Health Literacy in the Era of Secure Messaging

In this study, we will examine how diabetes patients with limited health literacy interact with their healthcare providers via secure messages (emails). We will employ computational linguistics and qualitative methods to develop and validate a novel "linguistic complexity profile” (LCP) and use the LCP scores to characterize the linguistic complexity of secure messages sent by patients and providers. We will then use LCP scores to examine whether providers adjust the linguistic complexity of their secure messages to match the complexity of a patient’s secure messages and whether this matching is associated with better medication adherence.
Investigator: Karter, Andrew
Funder: National Library of Medicine