Screening for Type 2 Diabetes Mellitus in Children and Adolescents: Attitudes, Barriers, and Practices Among Pediatric Clinicians
Division of Endocrinology, Children's Hospital Boston, MA 02115, USA. Ambulatory Pediatrics
(Impact Factor: 2.49).
03/2006; 6(2):110-4. DOI: 10.1016/j.ambp.2005.10.005
The American Diabetes Association (ADA) recommends screening children at risk for type 2 diabetes with a fasting plasma glucose test or an oral glucose tolerance test. The purpose of this study was to describe attitudes, barriers, and practices related to type 2 diabetes screening in children among pediatric clinicians.
Pediatricians, nurse practitioners and physician assistants from a multispecialty, group practice in Eastern Massachusetts completed a mailed survey. To assess screening practice, three vignettes were presented representing pediatric patients with low, moderately high, and high risk for type 2 diabetes. The moderately high-risk and high-risk patients met ADA criteria for screening. ADA-consistent practice was defined as only screening the moderately high-risk and high-risk patients; lower-threshold practice was defined as also screening the low-risk patient; and higher threshold practice was screening only the high-risk patient.
Sixty-two of 90 clinicians responded (69%). Based on intent to screen in the 3 vignettes, 21% of respondents reported ADA-consistent screening practice, 39% lower-threshold, and 35% higher-threshold screening practice. Five percent had incomplete or nonclassifiable responses. Many clinicians ordered screening tests other than those recommended by the ADA; few (< or =8% in any vignette) ordered only an ADA-recommended test. Preferences for nonfasting tests were influenced by nonmedical factors such as access to or cost of transportation. Inadequate patient education materials and unclear recommendations for appropriate screening methods were the most frequently reported moderate/strong barriers to screening.
Most respondents reported type 2 diabetes screening practices that differed from current ADA recommendations. Our findings suggest that type 2 diabetes screening tests must be practical for clinicians and patients if they are to be used in pediatric practice. Further study of the benefits and cost-effectiveness of type 2 diabetes screening in children is warranted to clarify the role and optimal methods for screening in pediatric primary care.
Available from: 18.104.22.168
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ABSTRACT: Despite the rising prevalence of T2DM in adolescents and the significant implication that this has for future health and healthcare, T2DM and more mild forms of impairment in glucose metabolism remain relatively uncommon in the general pediatric population, and there is no evidence that widespread screening for glucose abnormalities is cost-effective. Even among children presumed to be at high risk due to medical or family history, ethnicity, or associated comorbidities, the low prevalence of unrecognized T2DM in children and adolescents does not support extensive screening efforts of unselected patients. Furthermore, both clinicians and clinical investigators need to address the economic and ethical implications of identifying number of children with impaired glucose metabolism that far exceed those with frank diabetes. Until we have evidence for prevention of progression to diabetes and related comorbidities through early intervention in these children, the value of identifying them is uncertain. Rather, studies reviewed here suggest that screening for T2DM in the pediatric population should be clinically focused and take into account not only those risk factors identified in the ADA guidelines, but also the clinical context, pubertal status, and the results of simple screening measures such as fasting glucose and triglycerides. The aim of such screening should be the identification of overt T2DM early enough to minimize risk for acute and chronic complications. More outcome-based research is required before general screening to identify children and adolescents with prediabetes or insulinresistance can be recommended.
Endocrine Research 02/2008; 33(1-2):73-91. DOI:10.1080/07435800802080369 · 1.28 Impact Factor
Available from: Chizo Agwu
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ABSTRACT: There is debate about the rationale and the most cost-effective strategy for screening adults for type 2 diabetes and a paucity of literature on the subject in children. Although tests exist to detect undiagnosed type 2 diabetes, these tests have not been extensively studied in this age group, and the outcomes of additional years of treatment in these screening-detected individuals are currently unknown. Despite this, the American Diabetes Association (ADA) recommends opportunistic screening of at-risk children. The true prevalence of childhood type 2 diabetes is unknown in many countries and the natural history of the condition has not been fully delineated in this age group. This review evaluates the rationale for screening asymptomatic children and adolescents for type 2 diabetes using modified World Health Organisation (WHO) criteria. Br J Diabetes Vasc Dis 2008; 8: 163—168
The British Journal of Diabetes & Vascular Disease 07/2008; 8(4):163-168. DOI:10.1177/1474651408094746
Available from: Donna R Halloran
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ABSTRACT: Our goal was to estimate the quarterly prevalence of and evaluate trends for chronic medication use in children.
A cross-sectional study of ambulatory prescription claims data from 2002 to 2005 was conducted for a nationally representative sample of >3.5 million commercially insured children who were 5 to 19 years old. Prevalence of chronic medication use was measured quarterly for antihypertensives, antihyperlipidemics, type 2 antidiabetics, antidepressants, attention-deficit disorder and attention-deficit/hyperactivity disorder medications, and asthma-controller therapy.
First-quarter 2002 baseline prevalence of chronic medication use per 1000 child beneficiaries ranged from a high of 29.5 for antiasthmatics to a low of 0.27 for antihyperlipidemics. Except for asthma medication use, prevalence rates were higher for older teens aged 15 to 19 years. During the study period, the prevalence rate for type 2 antidiabetic agents doubled, driven by 166% and 135% increases in prevalence among females aged 10 to 14 and 15 to 19 years, respectively. Therapy classes with double-digit growth in prevalence of use were asthma medications (46.5%), attention-deficit disorder and attention-deficit/hyperactivity disorder medications (40.4%), and antihyperlipidemics (15%). Prevalence of use growth was more moderate for antihypertensives and antidepressants (1.8%). Rates of growth were dramatically higher among girls than boys for type 2 antidiabetics (147% vs 39%), attention-deficit disorder and attention-deficit/hyperactivity disorder medications (63% vs 33%), and antidepressants (7% vs -4%).
Prevalence of chronic medication use in children increased across all therapy classes evaluated. Additional study is needed into the factors influencing these trends, including growth in chronic disease risk factors, greater awareness and screening, and greater affinity toward early use of drug therapy in children.
PEDIATRICS 11/2008; 122(5):e1053-61. DOI:10.1542/peds.2008-0214 · 5.47 Impact Factor
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