Andrew J. Karter, PhD

People

Kaiser Permanente Division of Research
2000 Broadway
Oakland, CA 94612

andy.j.karter@kp.org
Kaiser Permanente Researcher Profiles

Andrew J. Karter, PhD, has been a Research Scientist at Kaiser Permanente Northern California's Division of Research for almost 30 years, playing a leading role since 1994 in the design and maintenance of the Diabetes Registry, which includes data on more than 400,000 patients. He received his doctorate in 1993 in epidemiology with a special emphasis on epidemiologic methods and biostatistics, and was awarded Phi Beta Kappa, Summa Cum Laude, and a Fulbright fellowship. Dr. Karter's work spans both epidemiology and health services research in diabetes and its complications, with a current focus on the areas of diabetes care for older patients, hypoglycemia, continuous glucose monitoring, medication adherence, health disparities, health literacy and provider communication, language barriers to care, impact of health information technology, financial barriers and cost-sharing, and pharmacoepidemiology research.

Current Position(s):

Research Scientist III, Division of Research, Kaiser Permanente Northern California
Associate Director, Diabetes Research for Equity through Advanced Multilevel Science Center for Diabetes Translational Research (DREAMS-CDTR)
Affiliate Professor, Department of Health Systems and Population Health, University of Washington
Adjunct Professor, Dept. of General Internal Med., University of California, San Francisco

Section Affiliations:

Health Care Delivery and Policy

Related Website(s):

Diabetes Study of Northern California (DISTANCE)

Studies

Relaxed Glycemic Control and the Risk of Infections in Older Adults with Type 2 Diabetes

Older adults with poorly controlled type 2 diabetes (T2D) have a higher risk of infection than patients with good glycemic control. However tight glycemic control (e.g., A1C under 7%) in older adults has other risks. In a longitudinal cohort of T2D patients age 65 and older, we will evaluate the incidence of infections when glycemic control is relaxed to levels recommended by current guidelines.
Investigator: Karter, Andrew
Funder: National Institute on Aging

Health Economic Analysis of Automated Insulin Delivery Systems

Safely administering insulin to manage blood glucose is challenging for people with type 1 diabetes (T1D). Artificial pancreas or automated insulin delivery (AID) systems mimic pancreatic function by measuring blood glucose (using real-time continuous glucose monitoring), calculating insulin requirements, and automatically delivering insulin via an insulin pump. This study will determine if AID systems provide good value compared with standard insulin delivery. We will support the external validation of a computer simulation model (Swedish National Diabetes Register T1D model) which will then be used to estimate the long-term cost-effectiveness (from the US health care system and payer perspective) of AID systems compared with standard therapy among T1D patients. This is a collaboration among DOR, University of Michigan, Jaeb Center for Health Research, and University of Oxford.
Investigator: Karter, Andrew
Funder: The Leona M. and Harry B. Helmsley Charitable Trust

Comparative effectiveness of intermittently scanned continuous glucose monitors among patients with basal-bolus insulin-treated type 2 diabetes

This study will characterize patients selected by their providers for intermittently-scanned, continuous glucose monitor (isCGM) initiation and estimate the effect of isCGM initiation (relative to non-initiators) on clinical outcomes. We hypothesize that 1) among basal-bolus insulin treated, type 2 diabetes patients, those with poorer glycemic control and history of acute metabolic events are more likely selected by physicians for isCGM initiation, and 2) isCGM initiation will result in significant improvement in glycemic control (based on hemoglobin A1c), reduced risk of hypoglycemia and hyperglycemia (both based on emergency department or hospital utilization), compared with non-initiators. This comparative effectiveness research will be based on a difference-in-differences analysis of changes in these outcomes associated with isCGM initiation, compared to a reference group of patients who do not use isCGM (usual care).
Investigator: Karter, Andrew
Funder: TPMG Delivery Science Projects Program

Quantifying Racial/ethnic Differences in the Relationship Between Glucose Concentrations and Hemoglobin A1c

Physicians rely on hemoglobin A1c (A1C), an integrated measure of glycemia (blood glucose), to make treatment decisions for patients with diabetes. There is evidence that, given comparable glycemia, A1C results in African Americans can be significantly higher than in whites with similar mean glucose. Racial differences in glycosylation (and thus differences in A1c results) could lead to inequities in diabetes diagnosis, performance measures (e.g., HEDIS), treatment (e.g., unnecessary treatment intensification), and hypoglycemia risk. It is unknown how the A1C-glucose relationship varies in other groups, e.g., Latinx or Asians. Further, it is unclear to what extent observed racial differences may be attributable to innate physiologic factors (e.g., sickle cell trait) or socioeconomics for which race may be a surrogate. We propose to collect glucose data from continuous glucose monitoring (CGM) devices and compare them to A1C data to better understand racial biases in the A1C-glucose relationship.
Investigator: Karter, Andrew
Funder: Northern California Community Benefit Programs

Optimizing Medical Decision-Making for Older Patients with Type 2 Diabetes

Medicare-age patients with type 2 diabetes are projected to double in the next 25 years and have high rates of complications and adverse drug events. However, older patients are largely excluded from the major clinical trials of diabetes care. This lack of clinical evidence has led to conflicting and ambiguous recommendations for care. The study will provide new evidence needed to care for these patients. Aim 1: Characterize variation in patient-reported outcomes, patient-provider relationships, and treatment preferences. Aim 2: Determine glycemic control levels associated with the lowest risk of adverse outcomes, including micro- and macrovascular outcomes, hypoglycemia, and death. Aim 3: Develop a risk-based decision support tool for evidence-based, individualized diabetes care for older adults with diabetes.
Investigator: Karter, Andrew
Funder: National Institute on Aging

Preferences, Management and Outcomes in the Oldest Patients with Diabetes

The aim of this study is to develop, pilot and conduct a survey among older diabetes patients (75 years of age or older) or their caregiver surrogates to collect data on: 1) self-management barriers (e.g., poor functional status, financial barriers, inadequate health literacy, depression); 2) treatment preferences (e.g., goals, attitudes regarding de-intensification and intensification, use of insulin, perceived risks and benefits of treatment); and 3) patient-reported outcomes (PROs) not commonly or comprehensively captured in the electronic medical record (e.g., health-related quality of life, falls, urinary incontinence, chronic pain).
Investigator: Karter, Andrew
Funder: National Institute of Diabetes and Digestive and Kidney Diseases

Highlighted Publications

Validation of a Hypoglycemia Risk Stratification Tool Using Data From Continuous Glucose Monitors

Author(s): Karter, Andrew J; Parker, Melissa M; Moffet, Howard H; Lipska, Kasia J; Ralston, James D; Huang, Elbert S; Gilliam, Lisa K

JAMA Netw Open. 2023 Mar 01;6(3):e236315. Epub 2023-03-01.

Current Position(s):

Section Affiliations:

Related Website(s):

Studies

Relaxed Glycemic Control and the Risk of Infections in Older Adults with Type 2 Diabetes

Health Economic Analysis of Automated Insulin Delivery Systems

Comparative effectiveness of intermittently scanned continuous glucose monitors among patients with basal-bolus insulin-treated type 2 diabetes

Quantifying Racial/ethnic Differences in the Relationship Between Glucose Concentrations and Hemoglobin A1c

Optimizing Medical Decision-Making for Older Patients with Type 2 Diabetes

Preferences, Management and Outcomes in the Oldest Patients with Diabetes

Highlighted Publications

Validation of a Hypoglycemia Risk Stratification Tool Using Data From Continuous Glucose Monitors

Continuous Glucose Monitor Use Prevents Glycemic Deterioration in Insulin-Treated Patients with Type 2 Diabetes

Association of Real-time Continuous Glucose Monitoring With Glycemic Control and Acute Metabolic Events Among Patients With Insulin-Treated Diabetes

Revalidation of the Hypoglycemia Risk Stratification Tool Using ICD-10 Codes

Surveillance of Hypoglycemia-Limitations of Emergency Department and Hospital Utilization Data

Effect of Out-of-Pocket Cost on Medication Initiation, Adherence, and Persistence among Patients with Type 2 Diabetes: The Diabetes Study of Northern California (DISTANCE)

High rates of severe hypoglycemia among African American patients with diabetes: the surveillance, prevention, and Management of Diabetes Mellitus (SUPREME-DM) network

Impact of a Pharmacy Benefit Change on New Use of Mail Order Pharmacy among Diabetes Patients: The Diabetes Study of Northern California (DISTANCE)

Elevated Rates of Diabetes in Pacific Islanders and Asian Subgroups: The Diabetes Study of Northern California (DISTANCE)

New prescription medication gaps: a comprehensive measure of adherence to new prescriptions

Publications

Glycemic Control Over Multiple Decades and Dementia Risk in People With Type 2 Diabetes

Development and Validation of a Diabetic Retinopathy Risk Stratification Algorithm

Data-driven classification of health status of older adults with diabetes: The diabetes and aging study

Racial and Ethnic Differences in Medication Initiation Among Adults Newly Diagnosed with Type 2 Diabetes

Validation of a Hypoglycemia Risk Stratification Tool Using Data From Continuous Glucose Monitors

Association of Low-Density Lipoprotein Testing after an Atherosclerotic Cardiovascular Event with Subsequent Statin Adherence and Intensification

Continuous Glucose Monitor Use Prevents Glycemic Deterioration in Insulin-Treated Patients with Type 2 Diabetes

Smoking and Risk of Premature Atherosclerotic Cardiovascular Disease

Comparison of cognitive function in older adults with type 1 diabetes, type 2 diabetes, and no diabetes: results from the Study of Longevity in Diabetes (SOLID)

Precision communication: Physicians' linguistic adaptation to patients' health literacy

Developing and Testing Automatic Models of Patient Communicative Health Literacy Using Linguistic Features: Findings from the ECLIPPSE study

The effect of mail order pharmacy outreach on older patients with diabetes

Descriptive examination of secure messaging in a longitudinal cohort of diabetes patients in the ECLIPPSE study

Association of Real-time Continuous Glucose Monitoring With Glycemic Control and Acute Metabolic Events Among Patients With Insulin-Treated Diabetes

Association of Type 1 Diabetes and Hypoglycemic and Hyperglycemic Events and Risk of Dementia

Is Shelter-in-Place Policy Related to Mail Order Pharmacy Use and Racial/Ethnic Disparities for Patients With Diabetes?

Validity of a Computational Linguistics-Derived Automated Health Literacy Measure Across Race/Ethnicity: Findings from The ECLIPPSE Project

Severe Hypoglycemia and Risk of Atherosclerotic Cardiovascular Disease in Patients With Diabetes

Employing computational linguistics techniques to identify limited patient health literacy: Findings from the ECLIPPSE study

A Randomized Encouragement Trial to Increase Mail Order Pharmacy Use and Medication Adherence in Patients with Diabetes

Challenges and solutions to employing natural language processing and machine learning to measure patients' health literacy and physician writing complexity: The ECLIPPSE study

Changes in Management of Type 2 Diabetes Before and After Severe Hypoglycemia

Recurrent diabetic ketoacidosis and cognitive function among older adults with type 1 diabetes: findings from the Study of Longevity in Diabetes

Initial Glycemic Control and Care Among Younger Adults Diagnosed With Type 2 Diabetes

Severe Hypoglycemia and Cognitive Function in Older Adults With Type 1 Diabetes: The Study of Longevity in Diabetes (SOLID)

Risk of atherosclerotic cardiovascular disease by cardiovascular health metric categories in approximately 1 million patients

Risk of atherosclerotic cardiovascular disease by cardiovascular health metric categories in approximately 1 million patients

Risk of Cardiovascular Events in Statin-Treated Patients with Type 2 Diabetes and Metabolic Dyslipidemia without Prevalent Atherosclerotic Cardiovascular Disease

Sleep Quality and Cognitive Function in Type 1 Diabetes: Findings From the Study of Longevity in Diabetes (SOLID)

Predicting the readability of physicians' secure messages to improve health communication using novel linguistic features: Findings from the ECLIPPSE study

Use and Discontinuation of Insulin Treatment Among Adults Aged 75 to 79 Years With Type 2 Diabetes

Secure Messaging with Physicians by Proxies for Patients with Diabetes: Findings from the ECLIPPSE Study

Opportunities to encourage mail order pharmacy delivery service use for diabetes prescriptions: a qualitative study

Visual outcomes after cataract surgery in patients with type 2 diabetes

The Legacy Effect in Type 2 Diabetes: Impact of Early Glycemic Control on Future Complications (the Diabetes & Aging Study)

Revalidation of the Hypoglycemia Risk Stratification Tool Using ICD-10 Codes

Response to Comment on Laiteerapong et al. The Legacy Effect in Type 2 Diabetes: Impact of Early Glycemic Control on Future Complications (The Diabetes & Aging Study). Diabetes Care 2019;42:XXXX-XXXX

Using natural language processing and machine learning to classify health literacy from secure messages: The ECLIPPSE study

Review of Metformin Use for Type 2 Diabetes Prevention

Traumatic brain injury associated with dementia risk among people with type 1 diabetes

Long-term Glycemic Control and Dementia Risk in Type 1 Diabetes

Risk of Incident Atherosclerotic Cardiovascular Disease Events by Achieved Atherogenic Lipid Levels Among 62,428 Statin-Treated Individuals With Diabetes Mellitus

Language barriers and LDL-C/SBP control among Latinos with diabetes

Brief Commentary: Glycemic Targets for Older Adults With Type 2 Diabetes

Eating with others and meal location are differentially associated with nutrient intake by sex: The Diabetes Study of Northern California (DISTANCE)

Association of Initiation of Basal Insulin Analogs vs Neutral Protamine Hagedorn Insulin With Hypoglycemia-Related Emergency Department Visits or Hospital Admissions and With Glycemic Control in Patients With Type 2 Diabetes

Surveillance of Hypoglycemia-Limitations of Emergency Department and Hospital Utilization Data

Adherence to Cardio-protective Medications Prescribed for Secondary Prevention after an Acute Coronary Syndrome Hospitalization Compared to Usual Care

Food Insecurity, Food "Deserts," and Glycemic Control in Patients With Diabetes: A Longitudinal Analysis

Improved Cardiovascular Risk Factors Control Associated with a Large-Scale Population Management Program Among Diabetes Patients

Depression in type 1 diabetes and risk of dementia

Effect of Out-of-Pocket Cost on Medication Initiation, Adherence, and Persistence among Patients with Type 2 Diabetes: The Diabetes Study of Northern California (DISTANCE)

The Bidirectional Association Between Depression and Severe Hypoglycemic and Hyperglycemic Events in Type 1 Diabetes

Development and Validation of a Tool to Identify Patients With Type 2 Diabetes at High Risk of Hypoglycemia-Related Emergency Department or Hospital Use

Hypoglycemia Patients and Transport by EMS in Alameda County, 2013-15

Association Between Neighborhood Supermarket Presence and Glycated Hemoglobin Levels Among Patients With Type 2 Diabetes Mellitus

High rates of severe hypoglycemia among African American patients with diabetes: the surveillance, prevention, and Management of Diabetes Mellitus (SUPREME-DM) network

Food Environment and Weight Change: Does Residential Mobility Matter?: The Diabetes Study of Northern California (DISTANCE)