1. Based on this randomized clinical trial, a computerized clinical decision support system that integrated guideline recommendations type 2 diabetes screening in high risk children lead to improved rates of screening.
2. Adherence to follow-up appointments was also improved following implementation of the automated system, but overall follow up was low.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Childhood obesity has increased rates of type 2 diabetes (T2D) amongst children. Early diagnosis is important for appropriate management of this chronic condition. The American Diabetes Association recommends laboratory screening for T2D in youths over 10-years old who are at or above the 85th percentile for BMI and have at least two other clinical risk factors. Overall, screening rates in this population are currently low. This cluster-randomized clinical trial aimed to determine if electronic medical record integration with an automated clinical support tool would help identify appropriate patients and increase rates of screening.
Over the 3-year study period, 41.3% of the patients qualified for T2D screening based on ADA guidelines. The clinics using the electronic clinical support tool had higher rates of T2D screening compared with the clinics not using the support tool. A greater proportion of individuals in the intervention arm attended follow-up appointments compared with those in the control arm. The strength of the study included the randomized design. However, since only four clinics were studied, the results may not be generalizable to other practice settings.
Relevant Reading: Screening Practices for Identifying Type 2 Diabetes in Adolescents
In-Depth [randomized controlled trial]: This randomized controlled trial was conducted at four clinics of the Eskenazi Health Center Primary Care system from 2013 to 2016. Two clinics were randomized to using an automated clinical decision tool integrated in the electronic medical record system to guide screening of high-risk children for T2D. The other two clinics were controls. Children who were patients of the respective clinics were included if they were at least 10-years old and had BMI data available in the EMR. The intervention (CHICA T2D module) first identified patents with BMI at or above the 85th percentile for age/sex and prompted the physician for additional clinical data regarding risk factors for T2D. If patients had two or more risk factors, then the module prompted the physician to arrange laboratory testing with either fasting plasma glucose or hemoglobin A1c. The primary outcome was screening rates in appropriate at-risk children.
Of the 1,369 patients included in the trial, 41.3% were identified as high risk for T2D and warranted screening per ADA guidelines. The intervention group had higher screening rates (31.4% vs 9.2%; aOR 3.7 [95%CI 1.8-7.7]) and greater proportion of patients who attended follow-up visits after screening (29.4% vs. 18.9%).
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