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


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.

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Available from: Beatriz L Rodriguez
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    • "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. "
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