RENO, NEV. — A novel screening program developed by researchers in North Carolina was able to identify children at risk for type 2 diabetes or prediabetes, and to facilitate lifestyle interventions, Dr. Elizabeth C. Tilson said at the annual meeting of the American College of Preventive Medicine.
However, the referral rate was lower than expected.
The type 2 diabetes (T2D) program was designed to identify children aged 10–18 years with type 2 diabetes, prediabetes, or metabolic syndrome. Children diagnosed with these conditions were referred to community-based exercise programs. They also participated in eight intensive family education sessions on nutrition, diet, and exercise. After the intervention ended, they were offered continuing membership in exercise programs near their homes, at reduced rates, said Dr. Tilson, medical director of Community Care of Wake/Johnston Counties, a quality improvement care management program for Medicaid patients.
“I think it is really important to set up routine screening criteria and a screening process for diabetes and prediabetes,” Dr. Tilson said in an interview. “With the epidemic of obesity in our children, more and more and more of them are going to have diabetes or prediabetes. It's really important to set up a systematic process so we can find these children early.”
The screening tool was designed to identify children aged 10 years or older with a body mass index (BMI) at the 85th percentile or higher for their age, plus one of the following risk factors: racial/ethnic minority, family history of type 2 diabetes, acanthosis nigricans, or hypertension. Children who met the criteria were referred for an analysis of fasting lipid and blood glucose levels.
The program was supported by a broad community collaboration that included funding from a private foundation, pilot testing through the local health department, and exercise programs at the YMCA and local parks. Screening was conducted by private pediatricians, while most of the lab tests were done at WakeMed Health and Hospitals, a nonprofit hospital system based in Raleigh, N.C. The screening tool was developed by the WakeMed pediatric diabetes program in collaboration with the local public health department and local medical society.
In July 2004, the T2D screening tool was made available to pediatricians in Wake County, N.C. During the next 18 months, 89 physicians in 37 practices referred a total of 747 patients for lab tests. Of those, 81% were screened, and 45% of those who were screened had abnormal lab values. Three cases of type 2 diabetes were diagnosed.
Although the screening form did accurately select children who should be screened for diabetes and prediabetes, the referral rate was lower than expected. Only 8% of children whose BMI was in the 85th–95th percentiles were referred for lab tests, while the referral rate for children with a BMI higher than 95th percentile was 52%. “We were shocked that the referral rate was so low. Because so many children are overweight, it appears we have become desensitized to this issue,” said Dr. Tilson.
The barriers to screening children for type 2 diabetes include physicians' busy schedules and parental resistance, Dr. Tilson said. In the future, the project will work to further identify and reduce barriers to screening.
“The increasing number of referrals shows that [the] T2D [program] and area pediatricians have formed effective partnerships,” she said. “However, the referral rates at present are not what we would like to see. Even when you have a system set up, you still have to work hard to maximize that system and really make sure you're identifying all the at-risk kids.”
For more information and copies of the screening form, e-mail Dr. Tilson at elizabeth.tilson@co.wake.nc.us