Sex-based differences in screening and recognition of pre-diabetes and type 2 diabetes in pediatric primary care.
Sex-based differences in screening and recognition of pre-diabetes and type 2 diabetes in pediatric primary care.
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DOI：
10.1111/ijpo.12699
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发表时间：
2021-03
影响因子：
3.8
通讯作者：
Kelly A
中科院分区：
文献类型：
--
作者：
Vajravelu ME;Lee JM;Amaral S;Kelly A
建议在超重/肥胖的青年中进行基于风险的2型糖尿病（T2 D）筛查，但实际上比率仍然很低。识别影响供应商订购和患者完成测试的因素可以指导改善筛查的策略。评价儿科初级保健中基于血红蛋白A1 c（A1 c）的T2 D筛查的预测因素。这项回顾性队列研究纳入了2009年至2018年在一个大型学术附属儿科初级保健网络中随访的10至18岁超重/肥胖（体重指数[BMI] Z评分≥1.04）患者。确定A1 c有序和完整患者的年龄，并使用多变量考克斯比例风险回归评估筛选的独立预测因素。纳入了34 927名（48.0%女性; 52.5% BMI Z评分≥1.64）随访中位数为3.0年的青年。随访期间，21%（7457）的患者接受了筛选，14%（4966）的患者完成了筛选。在多变量回归分析中，在控制了种族/民族、BMI、糖尿病家族史和年龄后，男性接受筛查的可能性显著降低，但如果接受筛查，男性完成筛查的可能性相同或更高。由于不同的排序做法，男性青少年不太可能接受基于A1 c的T2 D筛查。这种差异的做法的来源应追求，以避免认识不足的心脏代谢风险在高危男性青年。
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. To evaluate predictors of hemoglobin A1c (A1c)-based T2D screening in pediatric primary care. 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. 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. 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.
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