Week 1: The Beginning

Hi everyone! Today concluded my first week of my internship at Banner.

The first thing I learned from my mentor, Sumit, was how the entire healthcare system is structured. Because the main theme of my project is healthcare delivery, this helped me understand the process better. There are two main categories: the providers (hospitals, clinics, etc.) and the payers (insurance companies). Patients are seen by providers such as physicians and nurses as either an inpatient or outpatient. For my research, I will be looking into the records of these patients who came to Banner.

Before I get into details of the project, let me summarize how diabetes works. After you eat, the pancreas secretes the hormone called insulin which regulates the blood sugar level; it signals other cells to absorb the sugar, which can then be used for energy for your body. Insulin can also help store this sugar in the liver, and release it when your blood sugar level is too low. Now, when you eat constantly, and your blood sugar level is always high, the receptors on the pancreas start to get desensitized, and fail to properly detect sugar levels. When that happens, insulin isn't used adequately and the sugar in the blood does not get absorbed anymore, leading to high blood sugar levels, and eventually, diabetes. When this happens, it's known as diabetes type 2, which occurs mostly in adults.

There is also something called type 1 diabetes which results because of a congenital disease where the pancreas produces little or no insulin. In my research, I will be focusing on type 2 diabetes.

When doing prior research, I found that there were a few studies done on diabetic neuropathy; however, they were longitudinal studies done for only a couple of years. It's important to note that diabetic neuropathy progresses over many years, so the patients' health could have very well changed after the studies were finished. So, we decided it would be more insightful to do a retrospective study, analyzing patient records beginning from at least 5 years ago. In order to find a list of worthy patient records, we needed an end-point: a below-knee amputation. Patients who had an amputation show that their condition worsened to a point where they had to lose the area which was most affected by diabetic neuropathy. By selecting these patients, we can analyze all the variables which may have led to their amputation.

From the list of patients who received an amputation, we will separate them into two categories: those who were regular smokers or alcoholics, and those who were not. We predict that the average age of those who did not smoke or drink will be much higher than the average age of those who did. We also hypothesize that the HbA1c levels (which tell us the average blood sugar levels of a patient over a period of 3 months) will be higher in patients who were smokers or alcoholics.

The main program I will be using to analyze patient data is called Cerner, where all the records are stored. Firstly, we will get a list of all patients with diabetic neuropathy. Then, we will filter that to get a list of those who received a below-knee amputation. From there, we will separate the patients into smokers/alcoholics and those who were clean, and analyze the variables.

That was the overview of this week. Come back next week to stay updated!