Optimizing Glycemic Monitoring and Management in People with Type 2 Diabetes and Chronic Kidney Disease - Project Summary/Abstract This K23 proposal focuses on using continuous glucose monitoring (CGM) technology to optimize glycemic monitoring and management in people with type 2 diabetes and chronic kidney disease (CKD), fostering the career development of Mengyao Tang, MD, MPH, as an independent clinical researcher bridging diabetes and CKD research. Approximately 40% of individuals with type 2 diabetes develop CKD, a devastating complication that markedly amplifies risks for kidney failure, cardiovascular events, and premature death. Glycemic control is a cornerstone of diabetes management in CKD, yet the standard method of glycemic monitoring, HbA1c, is less accurate in CKD patients, and glycemic management is further complicated by heightened risk of hypoglycemia. CGM has revolutionized diabetes care, yet it remains under-studied and under- utilized in the CKD population. For the first time in CKD patients, Aim 1 will test the associations between CGM-based metrics (time in range and CGM-detected hypoglycemia) and long-term clinical outcomes (CKD progression, cardiovascular events, and mortality) in a large cohort. Furthermore, older adults with type 2 diabetes and CKD, who represent the largest CKD subpopulation, face unique multi-level barriers that may undermine the short-term benefits of CGM. Therefore, Aims 2 and 3 will use an implementation science framework to refine and pilot- test a supported CGM intervention to examine feasibility and short-term efficacy in this high-risk group. Dr. Tang is a board-certified nephrologist at Massachusetts General Hospital (MGH). Her career goal is to become a leading physician-scientist who implements patient-centered technology and treatments to improve clinical outcomes and quality of life for people with diabetes and CKD. Dr. Tang has assembled a multi-disciplinary mentoring and advisory team led by experts in endocrinology, nephrology, implementation science, biostatistics, and psychology. During her K23 grant period, Dr. Tang will acquire essential clinical investigation skills through a detailed career development plan, including formal coursework, attendance at conferences and seminars, and hands-on experience in CGM data analysis and clinical use, implementation science, and mixed methods research. Dr. Tang will thrive in the rich environment at MGH, which is deeply committed to her success as a junior faculty member. In summary, this K23 project will lay the groundwork for a hybrid effectiveness-implementation trial of using CGM (vs. HbA1c alone) to optimize diabetes management in older adults with type 2 diabetes and CKD. The project will also foster cross-disciplinary collaborations and provide a robust training and research niche for Dr. Tang, facilitating her development into a successful, independent clinical researcher.
