Sex‐based differences in screening and recognition of pre‐diabetes and type 2 diabetes in pediatric primary care
Year: 2020
Type: article
Study design: Observational Study
Abstract: 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.
Source: Pediatric Obesity
DOI: 10.1111/ijpo.12699
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funders: Cystic Fibrosis Foundation, Juvenile Diabetes Research Foundation United States of America, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Child Health and Human Development, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: VIRTUUS Children's Study: Validating Injury to the Renal Transplant Using Urinary Signatures in Children, Conventional and Metabolomic Predictors of Pediatric Prediabetes & Insulin Resist, Cardiometabolic Health in Adolescents of South Asian Ancestry - the CHAriSmA study, G2028165844, G4032531109, Career Development Program in Pediatric Diabetes Research (K12) at CHOP, Urological and Renal Disease Engaging Adolescents in Adherence Collaborative Trial, G6559676388, Evaluation of the entero-insular (incretin) axis in cystic fibrosis-competitive renewal., Target self-regulation to promote adherence and health behaviors in children, Reaching Equity for Adults and CHildren in Transplant (REACH-TRANSPLANT), Michigan Center for Diabetes Translational Research
OpenAlex ID: W3046144375