PROJECT SUMMARY/ABSTRACT
Breast cancer (BC) survivors are the largest cancer survivor group (~4 million in the US) given improvements
in screening and long-term BC survival. While BC progression is a concern in this group, many BC survivors
die of comorbid illness. Specifically, type 2 diabetes (T2DM) is a major comorbidity (prevalence 20%)
associated with increased morbidity and mortality in BC survivors. Thus, optimizing T2DM treatment can have
a major beneficial impact in clinical outcomes. However, data regarding the optimal T2DM treatment strategies
in BC survivors, particularly taking into account novel T2DM drugs, is limited. The harm/benefit ratio of different
T2DM treatment approaches is likely significantly different for BC survivors due to an increased risk of T2DM
complications (particularly cardiovascular disease [CVD] in setting of cardiotoxic BC treatments), unique harms
from T2DM treatments, higher competing risks of death from BC, and differences in baseline QOL. To address
this knowledge gap, I plan to develop and validate a simulation model to recapitulate the natural history,
management, and outcomes of T2DM in BC survivors (Aim 1). I then will determine the most effective T2DM
treatment strategy (according to age, stage, primary BC therapy, BC recurrence, CVD) in terms of glycemic
control intensity (intensive vs. moderate) and first-line drugs (metformin, SGTL2i, GLP1ra vs. SGTL2i/GLP1ra
combined) for Stage II-III BC survivors 2) (Aim 2). I am an endocrinologist and my career goal is to optimize
diabetes care for cancer survivors and other understudied populations with complex comorbidity using
innovative simulation modeling approaches. My proposed training plan focuses on the following domains: 1)
Advanced statistical and epidemiological methods (quality of life, longitudinal data, and missing data
imputation); 2) Simulation modeling and translation into practice; and 3) Leadership in research and career
development (scientific communication, grant writing, etc.). I have assembled an interdisciplinary experienced
mentorship team with expertise in diabetes, cancer survivorship epidemiology, biostatistics, and simulation
modeling. I will complete my training at the Icahn School of Medicine at Mount Sinai, a national leader in
research and one of the top 20 medical schools for research in the country. I have a mentorship team
committed to the success of my proposal and my development into a competitive researcher for R-level grants