Screening for Type 2 Diabetes Mellitus in Children and Adolescents: Attitudes, Barriers, and Practices Among Pediatric Clinicians

Rhodes, Erinn T.; Finkelstein, Jonathan A.; Marshall, Richard; Allen, Carole; Gillman, Matthew W.; Ludwig, David S.

doi:10.1016/j.ambp.2005.10.005

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Volume 6, Issue 2 , Pages 110-114, 1 March 2006

Screening for Type 2 Diabetes Mellitus in Children and Adolescents: Attitudes, Barriers, and Practices Among Pediatric Clinicians

Presented in part at the Pediatric Academic Societies’ 2004 Annual Meeting, San Francisco, Calif, May 1-4, 2004.

Erinn T. Rhodes, MD, MPH
- Division of Endocrinology, Children’s Hospital Boston, Boston, Mass
- Department of Pediatrics, Harvard Medical School, Boston, Mass
- Harvard Pediatric Health Services Research Fellowship Program, Boston, Mass
- Address correspondence to Erinn T. Rhodes, MD, MPH, Division of Endocrinology, Children’s Hospital Boston, 333 Longwood Avenue 6th Floor, Boston, MA 02115
Jonathan A. Finkelstein, MD, MPH
- Department of Pediatrics, Harvard Medical School, Boston, Mass
- Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass
- Harvard Vanguard Medical Associates, Boston, Mass
Richard Marshall, MD
- Harvard Vanguard Medical Associates, Boston, Mass
Carole Allen, MD
- Harvard Vanguard Medical Associates, Boston, Mass
Matthew W. Gillman, MD, SM
- Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass
- Department of Nutrition, Harvard School of Public Health, Boston, Mass
David S. Ludwig, MD, PhD
- Division of Endocrinology, Children’s Hospital Boston, Boston, Mass
- Department of Pediatrics, Harvard Medical School, Boston, Mass

Received 19 January 2005; accepted 28 October 2005.

Objective

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.

Methods

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.

Results

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 (≤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.

Conclusions

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.

Key words: blood glucose , children , guidelines , screening , type 2 diabetes