title: Pediatric endocrinologists' management of children with type 2 diabetes.
abstract: OBJECTIVE To understand physician behaviors and attitudes in managing children with type 2 diabetes. RESEARCH DESIGN AND METHODS A survey was mailed to a nationwide sample of pediatric endocrinologists (PEs). RESULTS A total of 40% of PEs surveyed responded (211 of 527). Concordance with current monitoring guidelines varied widely, ranging from 36% (foot care) to 93% (blood pressure monitoring). Given clinical vignettes addressing hyperlipidemia, hypertension, and microalbuminuria, only 34% of PEs were fully concordant with current treatment guidelines. Reported barriers included concerns about patient adherence, insufficient scientific evidence about treatment, and lack of familiarity with current recommendations. Providers aged < or =45 years or in clinical practice <10 years reported significantly more aggressive management behaviors and had higher concordance with guidelines. CONCLUSIONS Screening and management of pediatric type 2 diabetes varied widely among PEs, suggesting opportunities for quality improvement. More aggressive management of type 2 diabetes among younger providers may be related to recent training when type 2 diabetes was more common.
authors.affiliation: Departments of Medicine and Pediatrics, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: Kam
authors.initials: K
authors.lastname: Wong
authors.forename: Amy
authors.initials: A
authors.lastname: Potter
authors.forename: Shelagh
authors.initials: S
authors.lastname: Mulvaney
authors.forename: William E
authors.initials: WE
authors.lastname: Russell
authors.forename: David G
authors.initials: DG
authors.lastname: Schlundt
authors.forename: Russell L
authors.initials: RL
authors.lastname: Rothman
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003625:Data Collection; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D004704:Endocrinology / Q000379:methods*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D010372:Pediatrics / Q000379:methods; D011361:Professional Competence; D011364:Professional Practice