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|Title||Sex-based differences in screening and recognition of pre-diabetes and type 2 diabetes in pediatric primary care.|
|Publication Type||Journal Article|
|Year of Publication||2020|
|Authors||Vajravelu MEllen, Lee JM, Amaral S, Kelly A|
|Date Published||2020 Jul 26|
BACKGROUND: Risk-based screening for type 2 diabetes (T2D) in youth with overweight/obesity is recommended, but rates remain low in practice. Identification of factors impacting provider ordering and patient completion of testing may guide strategies to improve screening.
OBJECTIVE: To evaluate predictors of hemoglobin A1c (A1c)-based T2D screening in pediatric primary care.
METHODS: This retrospective cohort study included 10 to 18 year-old patients with overweight/obesity (body mass index [BMI] Z-score ≥1.04) followed in a large academic-affiliated pediatric primary care network, 2009 to 2018. Percentages of patients with ordered and completed A1c were determined, and multivariable Cox proportional hazards regression was used to evaluate independent predictors of screening.
RESULTS: 34 927 (48.0% female; 52.5% with BMI Z-score ≥1.64) youth followed for a median of 3.0 years were included. 21% (7457) of patients had screening ordered and 14% (4966) completed screening during follow-up. In multivariable regression, after controlling for race/ethnicity, BMI, family history of diabetes and age, males were significantly less likely to have ordered screening, but were equally or more likely to complete screening if ordered.
CONCLUSIONS: Male adolescents were less likely to undergo A1c-based T2D screening due to differential ordering practices. The source of this differential practice should be pursued to avoid under-recognition of cardiometabolic risk in at-risk male youth.
|Alternate Journal||Pediatr Obes|
|Grant List||PROMISE-OGTT18K0 / / Cystic Fibrosis Foundation / |
RUBEN16A0 / / Cystic Fibrosis Foundation /
R01HD074559 / / Eunice Kennedy Shriver National Institute of Child Health and Human Development /
R01HD091185 / / Eunice Kennedy Shriver National Institute of Child Health and Human Development /
UH3HD087979 / / Eunice Kennedy Shriver National Institute of Child Health and Human Development /
/ / Juvenile Diabetes Research Foundation United States of America /
/ / M-Diabetes Center of Excellence /
2R56 DK97830-06 / DK / NIDDK NIH HHS / United States
5K12DK094723-08 / DK / NIDDK NIH HHS / United States
R01DK110749 / DK / NIDDK NIH HHS / United States
R01DK115648 / DK / NIDDK NIH HHS / United States
R01DK120886 / DK / NIDDK NIH HHS / United States