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Diabetes screening practices in children vary widely among pediatric clinicians

As U.S. obesity rates have risen, so has the incidence of type 2 diabetes (previously called adult-onset diabetes) among U.S. children. It is enough of a concern that the American Diabetes Association (ADA) recommends screening for type 2 diabetes in moderate- and high-risk children, but only one-fifth of clinicians follow these screening guidelines, concludes a new study. The ADA recommends a fasting plasma glucose (FPG) test or an oral glucose tolerance test (OGTT), which should be done twice at different times to confirm a diagnosis of diabetes.

However, clinicians prefer screening tests that don't require a second visit, notes Erinn T. Rhodes, M.D., M.P.H., of Harvard Medical School. In a study supported in part by the Agency for Healthcare Research and Quality (T32 HS00063), Dr. Rhodes and colleagues analyzed responses to a mailed survey of 62 pediatricians, nurse practitioners, and physician assistants from a group practice. The survey addressed attitudes, barriers, and practices related to type 2 diabetes screening of children. Most respondents reported type 2 diabetes screening practices that differed from current ADA recommendations, and screening practices varied widely.

When presented with three hypothetical vignettes of pediatric patients with low, moderately high, and high risk of type 2 diabetes, 21 percent of clinicians screened only moderately high and high-risk patients as recommended by the ADA. An additional 39 percent also screened low-risk children, and 35 percent screened only high-risk children. Clinicians rarely used FPG or OGTT alone, but used these along with other tests in about one-third to one-half of patients screened. One-third of respondents were likely to order a nonfasting (random) glucose test instead of a fasting glucose test for the average patient. The findings suggest that type 2 diabetes screening tests must be practical for clinicians and patients, if they are to be used in pediatric practice.

More details are in "Screening for type 2 diabetes mellitus in children and adolescents: Attitudes, barriers, and practices among pediatric clinicians," by Dr. Rhodes, Jonathan A. Finkelstein, M.D., M.P.H., Richard Marshall, M.D., and others, in the March-April 2006 Ambulatory Pediatrics 6(2), pp. 110-114.

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