Adherence to Guidelines for Youths With Diabetes Mellitus

Pacific Health Research Institute, Honolulu, Hawaii, USA.
PEDIATRICS (Impact Factor: 5.47). 08/2011; 128(3):531-8. DOI: 10.1542/peds.2010-3641
Source: PubMed

ABSTRACT To describe demographic and clinical characteristics associated with self-reported receipt of tests and measurements recommended by the American Diabetes Association (ADA) for children and youths with diabetes.
The study included 1514 SEARCH for Diabetes in Youth study participants who completed a survey about diabetes care received. Quality-of-care measures were based on ADA guidelines for eye examinations and glycohemoglobin (hemoglobin A1c [HbA1c]), lipid level, microalbuminuria, and blood pressure measurements, and a composite variable of these 5 indicators was created. Multivariate logistic regression models were used to assess the association of selected demographic and clinical characteristics with the reported receipt of all recommended tests and measurements according to age and diabetes type subgroups.
Overall, 95% of the participants reported having their blood pressure checked at all or most visits, 88% had lipid levels measured, 83% had kidney function tested, 68% underwent HbA1c testing, and 66% underwent an eye examination, in accordance with ADA recommendations. Participants aged 18 years or older, particularly those with type 2 diabetes, tended to have fewer tests of all kinds performed. Age and family income emerged as important correlates of overall quality of care in multivariate models; older age and lower income were associated with not meeting guidelines.
Although there was relatively good adherence to ADA-recommended guidelines for most indicators, efforts are needed to improve rates of HbA1c testing and eye examinations, particularly among older youths.

Download full-text


Available from: Beatriz L Rodriguez, Sep 26, 2015
18 Reads
  • Source
    • "Our findings regarding provider characteristics are consistent with the multicenter, population-based SEARCH for Diabetes in Youth Study, which showed that 70% of 363 subjects ≥18 years of age (mean age 21.2 ± 2.3 years) were seeing a diabetes specialist (25% reported a pediatric endocrinologist and 45% an adult endocrinologist) while 17% were seeing a generalist. Subjects seeing a generalist were significantly less likely to report receipt of recommended diabetes screening tests compared with those seeing an endocrinologist.34 Variation in the nature and quality of diabetes care from different types of adult providers requires further study, and transition preparation may need to be tailored to the type of adult provider a patient will be seeing following transfer. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to describe the current status of adult diabetes care in young adults with type 1 diabetes and examine associations between health care transition experiences and care utilization. We developed a survey to assess transition characteristics and current care in young adults with type 1 diabetes. We mailed the survey to the last known address of young adults who had previously received diabetes care at a tertiary pediatric center. Of 291 surveys sent, 83 (29%) were undeliverable and three (1%) were ineligible. Of 205 surveys delivered, 65 were returned (response rate 32%). Respondents (mean age 26.6 ± 3.0 years, 54% male, 91% Caucasian) transitioned to adult diabetes care at a mean age of 19.2 ± 2.8 years. Although 71% felt mostly/completely prepared for transition, only half received recommendations for a specific adult provider. Twenty-six percent reported gaps exceeding six months between pediatric and adult diabetes care. Respondents who made fewer than three diabetes visits in the year prior to transition (odds ratio [OR] 4.5, 95% confidence interval [CI] 1.2-16.5) or cited moving/relocation as the most important reason for transition (OR 6.3, 95% CI 1.3-31.5) were more likely to report gaps in care exceeding six months. Patients receiving current care from an adult endocrinologist (79%) were more likely to report at least two diabetes visits in the past year (OR 6.0, 95% CI 1.5-24.0) compared with those receiving diabetes care from a general internist/adult primary care doctor (17%). Two-thirds (66%) reported receiving all recommended diabetes screening tests in the previous year, with no difference according to provider type. In this sample, transition preparation was variable and one quarter reported gaps in obtaining adult diabetes care. Nevertheless, the majority endorsed currently receiving regular diabetes care, although visit frequency differed by provider type. Because locating patients after transition was incomplete, our findings suggest the need for standardized methods to track transitioning patients.
    Patient Preference and Adherence 08/2013; 7:761-9. DOI:10.2147/PPA.S45823 · 1.68 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update. The Statistical Update is a critical resource for researchers, clinicians, healthcare policy makers, media professionals, the lay public, and many others who seek the best available national data on heart disease, stroke, and other cardiovascular disease-related morbidity and mortality and the risks, quality of care, use of medical procedures and operations, and costs associated with the management of these diseases in a single document. Indeed, since 1999, the Statistical Update has been cited >10 500 times in the literature, based on citations of all annual versions. In 2012 alone, the various Statistical Updates were cited ≈3500 times (data from Google Scholar). In recent years, the Statistical Update has undergone some major changes with the addition of new chapters and major updates across multiple areas, as well as increasing the number of ways to access and use the information assembled. For this year's edition, the Statistics Committee, which produces the document for the AHA, updated all of the current chapters with the most recent nationally representative data and inclusion of relevant articles from the literature over the past year. This year's edition includes a new chapter on peripheral artery disease, as well as new data on the monitoring and benefits of cardiovascular health in the population, with additional new focus on evidence-based approaches to changing behaviors, implementation strategies, and implications of the AHA's 2020 Impact Goals. Below are a few highlights from this year's Update.
    Circulation 12/2012; 127(1). DOI:10.1161/CIR.0b013e31828124ad · 14.43 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To describe adherence to clinical practice guidelines for the treatment of childhood type 1 diabetes and identify associated patient and system level factors. Study design: This prospective cohort study used population-based administrative data to describe individuals aged 1-24 years who had been diagnosed with type 1 diabetes at <20 years of age (1472 unique individuals and 5883 person-years over a 7-year period) living in British Columbia, Canada. The outcome measure was proportion 'at goal,' which was defined as having optimal adherence (3 diabetes-related physician visits/year, 3 hemoglobin A1c (HbA1c) tests/year, 1 glucagon prescription dispensed/year, and appropriate screening for diabetes-related comorbidity [ie, hypothyroidism] and complications [ie, retinopathy and nephropathy]), or good adherence to guidelines (2 diabetes-related physician visits/year, 2 HbA1c tests/year, and appropriate screening for diabetes-related comorbidity and complications). Statistical methods included descriptive statistics and logistic regression modeling. Results: Fifty-four percent person-years had poor adherence to guidelines (<2 diabetes-related physician visits and HbA1c tests/year) and 7.4% had optimal adherence. The proportion of person-years at goal was higher in females vs males (41.0% vs 37.6%; P = .007). Individuals 4-years post-diagnosis of diabetes were 78% less likely to be at goal compared with the year of diagnosis (P < .0001). Conclusions: The treatment of pediatric type 1 diabetes likely does not meet national and international standards. Future studies should explore facilitators and barriers to adherence to guidelines among health care providers, patients, and families, and whether adherence to guidelines is associated with glycemic control.
    The Journal of pediatrics 03/2013; 163(2). DOI:10.1016/j.jpeds.2013.01.070 · 3.79 Impact Factor
Show more