Computer Automation for Diagnosis and Management of Childhood Type 2 Diabetes
Condition: Type 2 Diabetes
MeSH terms: Diabetes Mellitus; Diabetes Mellitus, Type 2
Study type: Interventional

Summary: 
      Increasing rates of type 2 diabetes among children and adolescents has considerable long-term
      implications not only for the affected individuals, but also for society and the health
      system as a whole. Pediatricians have unique and important opportunities to screen for type 2
      diabetes and to promote lifestyle modification for those children identified with
      pre-diabetes; yet implementation of these practices within the pediatric primary care setting
      is far from ideal. The purpose of this study is to implement the ADA screening guidelines for
      type 2 diabetes and clinical management prompts within a pediatric primary care setting using
      a computer decision support system (CDSS) developed by the investigators research group - the
      Child Health Improvement through Computer Automation (CHICA) system. The investigators
      hypothesize that the coupling of CDSS with ADA guidelines will result in greater compliance
      with ADA recommended screening procedures as well as better clinical management of children
      identified as having pre-diabetes or type 2 diabetes.
    

Detailed description: 
      As the prevalence of obesity in the United States has risen, so too has the prevalence of
      type 2 diabetes, a disease typically associated with adults. The American Diabetes
      Association (ADA) has recommended screening children 10 years of age or older who are at
      substantial risk for the presence or development of type 2 diabetes. They also recommend that
      primary prevention efforts, such as lifestyle modification, be directed to high-risk children
      whose glucose levels are elevated but not yet diagnostic of diabetes. The choice of screening
      methodology remains controversial and implementation within the pediatric primary care
      setting is far from ideal. The purpose of this study is to implement the ADA screening
      guidelines for type 2 diabetes within pediatric primary care practices using a computer
      decision support system (CDSS) developed by the investigators research group - the Child
      Health Improvement through Computer Automation (CHICA) system. Using the CHICA system the
      investigators will also be implementing clinical management prompts for the pediatrician
      caring for children with risk factors for type 2 diabetes, with impaired fasting glucose
      (IFG), or with fasting glucose indicating the possibility of diabetes. One of the greatest
      strengths of the CHICA system is its ability to implement evidence-based recommendations from
      authoritative sources, in this case the ADA, in a format that integrates easily into routine
      pediatric care; the system can therefore overcome many of the barriers described by
      pediatricians to the screening of type 2 diabetes in children. While the use of CDSS is not
      new, its application within the pediatric population has not been as pervasive as in adult
      medicine. Moreover, the application of CDSS to the screening, diagnosis and management of
      type 2 diabetes in children is relatively unexplored. The specific aims for this study are
      to: (1) Expand and modify an existing computer-based decision support system (CHICA), to
      identify those children 10 years of age or older who are at increased risk for type 2
      diabetes, to provide pediatric physicians guidelines to screen for type 2 diabetes, and to
      coordinate the diagnosis and long-term management of the condition and (2) Demonstrate both
      the feasibility and effectiveness of the CHICA Type 2 Diabetes Module to recognize those
      children in need of screening for type 2 diabetes and facilitate prompt diagnosis and
      management of the condition. Phase one (Aim 1) focuses on programming and enhancements to the
      CHICA system and will take 12 months to complete. Phase two consists of a randomized
      controlled trial conducted in four pediatric clinics in order to evaluate Aim 2.
      Randomization will be by clinic and the investigators hypothesize that the coupling of CDSS
      with ADA guidelines will result in greater compliance with ADA recommended screening
      procedures as well as better clinical management of children identified as having
      pre-diabetes or type 2 diabetes. Phase two will begin in year 2 and continue through quarter
      2 of year 4. Phase three involves statistical analysis and manuscript preparation.
    

Intervention name(s): CHICA Type 2 Diabetes Module
Intervention type(s): Other
Intervention description(s): Information with regard to family history of type 2 diabetes, race/ethnicity, and maternal history of gestational diabetes will be gathered for every patient. This data will then be utilized by the CHICA system when a child is age 10 or older and presents to the clinic. Data regarding the child's BMI at that time will be analyzed by the CHICA system. If the child's BMI > 85th percentile, a prompt will appear on the provider worksheet asking the clinician whether the child might have insulin resistance. All information will then be analyzed to determine whether the child has 2 or more risk factors for the development of type 2 diabetes. If at least 2 risk factors are present, then the CHICA system goes on to coordinate the diagnosis and long-term management of type 2 diabetes.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Screening
Keywords: Type 2 Diabetes; Pediatrics; Computerized Decision Support System