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(Theory & Practicum)

Article Summary.

Hiba Makki.
May 18, 2011.
Submitted to: Ms. May Khoury.

Screening for 1ype 2 Diabetes Mellitus in
Children and Adolescents: Attitudes, Barriers,
and Practices Among Pediatric Clinicians.

%he American Diabetes Association (ADA) recommends screening children at risk
Ior type 2 diabetes with a Iasting plasma glucose test or an oral glucose tolerance
test. %he purpose oI this study was to describe attitudes, barriers, and practices
related to type 2 diabetes screening in children among pediatric clinicians. In 1960,
the incidence oI Diabetes Mellitus type 2 has risen in the United States, in addition
to the prevalence oI obesity that was considered as a risk Iactor oI Diabetes.
Patients, starting Irom the age oI 10, participated in this study in which they have
to meet certain criteria and two tests were used: Fasting plasma glucose (FPG) test
and an oral glucose tolerance test (OG%%). FPG was cited as the preIerred test
because oI its "lower cost and greater convenience.
Hypothesis: There would be infrequent screening of youth at moderately high risk
of diabetes type 2 and preference for screening tests not requiring a second visit.
Personnel: Pediatricians, nurse practitioners and physician assistants Irom
multispecialty, group practice in Eastern Massachusetts.
Used Method: Mailed survey using the Health BelieI Model as a Iramework.
Setting: Harvard Vanguard Medical Associates, a large, multispecialty group
practice with a population oI approximately 71 000 children in 14 practices in
Eastern Massachusetts.
%o assess screening practice, three vignettes were presented representing pediatric
patients with low, moderately high, and high risk Ior type 2 diabetes. %he
moderately high-risk and high-risk patients met ADA criteria Ior screening. ADA-
consistent practice was deIined as only screening the moderately high-risk and
high-risk patients; lower-threshold practice was deIined as also screening the low-
risk patient; and higher threshold practice was screening only the high-risk patient.
%he three vignettes were distributed as Iollowing:
1- %he low-risk patient had BMI at the 88th percentile and no additional type
2 diabetes risk Iactors.

2- %he moderately high-risk patient had BMI at 88th percentile with 2
additional risk Iactors: AIrican- American race and a second-degree relative
with type 2 diabetes.
3- %he high risk patients had BMI at 98th percentile with multiple risk
Iactors: Hispanic ethnicity, ac-anthosis Nigerians, borderline hypertension,
and 2 obese parents with type 2 diabetes.
Requirements: Respondents were told to assume that the patient was seen aIter
lunch, had no medical problems, took no medications, and had a normal
physical examination
O Attitudes and Barriers
- 76 agreed with a statement that type 2 diabetes was as serious as
Diabetes type1.
- Almost halI (40) agreed that screening Ior type 2 diabetes would
improve compliance with weight reduction eIIorts iI the results were
- Only halI (52) oI respondents agreed that a clinician could have an
eIIect on the dietary behavior oI an overweight patient iI they took
the time to discuss the problem.
%he most Irequently reported moderate/strong barriers to screening included
inadequate patient education materials (47), unclear recommendations Ior
appropriate screening methods (45), limited clinician time to provide appropriate
counseling related to screening (42), perception by patient or Iamily that
screening is unnecessary (40), or anticipated noncompliance with screening or
Iuture treatment Ior type 2 diabetes (39).
Conclusions: Most respondents reported type 2 diabetes screening practices that
diIIered Irom current ADA recommendations. Our Iindings suggest that type 2
diabetes screening tests must be practical Ior clinicians and patients iI they are to
be used in pediatric practice. Further study oI the beneIits and cost-eIIectiveness oI
type 2 diabetes screening in children is warranted to clariIy the role and optimal
methods Ior screening in pediatric primary care.