Screening for type 2 diabetes mellitus in children and adolescents: attitudes, barriers, and practices among pediatric clinicians.
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 (< or =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.
Rhodes
Erinn T
ET
Division of Endocrinology, Children's Hospital Boston, MA 02115, USA. erinn.rhodes@childrens.harvard.edu
Finkelstein
Jonathan A
JA
Marshall
Richard
R
Allen
Carole
C
Gillman
Matthew W
MW
Ludwig
David S
DS
D000293:Adolescent; D001291:Attitude of Health Personnel; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005951:Glucose Tolerance Test; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards* / Q000639:trends; D008404:Massachusetts; D010372:Pediatrics / Q000592:standards* / Q000639:trends; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment; D011795:Surveys and Questionnaires
D001786:Blood Glucose