Diabetes Mellitus Screening in Pediatric Primary Care

Boston University, Boston, Massachusetts, United States
PEDIATRICS (Impact Factor: 5.47). 11/2006; 118(5):1888-95. DOI: 10.1542/peds.2006-0121
Source: PubMed


The goal was to determine the rates of diabetes screening and the prevalence of screening abnormalities in overweight and nonoverweight individuals in an urban primary care clinic.
This study was a retrospective chart review conducted in a hospital-based urban primary care setting. Deidentified data for patients who were 10 to 19 years of age and had > or = 1 BMI measurement between September 1, 2002, and September 1, 2004, were extracted from the hospital electronic health record.
A total of 7710 patients met the study criteria. Patients were 73.0% black or Hispanic and 47.0% female; 42.0% of children exceeded normal weight, with 18.2% at risk for overweight and 23.8% overweight. On the basis of BMI, family history, and race, 8.7% of patients met American Diabetes Association criteria for type 2 diabetes mellitus screening, and 2452 screening tests were performed for 1642 patients. Female gender, older age group, and family history of diabetes were associated with screening. Increasing BMI percentile was associated with screening, exhibiting a dose-response relationship. Screening rates were significantly higher (45.4% vs 19.0%) for patients who met the American Diabetes Association criteria; however, less than one half of adolescents who should have been screened were screened. Abnormal glucose metabolism was seen for 9.2% of patients screened.
This study shows that, although pediatricians are screening for diabetes mellitus, screening is not being conducted according to the American Diabetes Association consensus statement. Point-of-care delivery of consensus recommendations could increase provider awareness of current recommendations, possibly improving rates of systematic screening and subsequent identification of children with laboratory evidence of abnormal glucose metabolism.

Download full-text


Available from: Supriya D Mehta, Apr 24, 2014
  • Source
    [Show abstract] [Hide abstract]
    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.
    Preview · Article · Feb 2008 · Endocrine Research
  • Source
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Nov 2008 · PEDIATRICS
  • [Show abstract] [Hide abstract]
    ABSTRACT: This review assessed the use of electronic medical record (EMR) systems in outcomes research. We systematically searched PubMed to identify articles published from January 2000 to January 2007 involving EMR use for outpatient-based outcomes research in the United States. EMR-based outcomes research studies (n = 126) have increased sixfold since 2000. Although chronic conditions were most common, EMRs were also used to study less common diseases, highlighting the EMRs' flexibility to examine large cohorts as well as identify patients with rare diseases. Traditional multi-variate modeling techniques were the most commonly used technique to address confounding and potential selection bias. Data validation was a component in a quarter of studies, and many evaluated the EMR's ability to achieve similar results previously achieved using other data sources. Investigators using EMR data should aim for consistent terminology, focus on adequately describing their methods, and consider appropriate statistical methods to control for confounding and treatment-selection bias.
    No preview · Article · Apr 2009 · Medical Care Research and Review
Show more