Computer Automation for Diagnosis and Management of Childhood Type 2 Diabetes

描述（由申请人提供）：随着肥胖症在美国的流行率上升，2型糖尿病的流行率也在上升，2型糖尿病是一种通常与成人相关的疾病。美国糖尿病协会（ADA）建议筛查10岁或以上的儿童，这些儿童存在或发展2型糖尿病的重大风险。他们还建议，一级预防措施，如生活方式的改变，应针对血糖水平升高但尚未诊断为糖尿病的高危儿童。筛查方法的选择仍然存在争议，在儿科初级保健环境中的实施还远远不够理想。本研究的目的是使用我们的研究小组开发的计算机决策支持系统（CDSS）-通过计算机自动化改善儿童健康（CHICA）系统，在儿科初级保健实践中实施ADA 2型糖尿病筛查指南。使用CHICA系统，我们还将为儿科医生提供临床管理提示，以照顾具有2型糖尿病风险因素的儿童，空腹血糖受损（IFG）或空腹血糖提示糖尿病可能性的儿童。CHICA系统的最大优势之一是它能够以一种易于整合到常规儿科护理中的形式实施来自权威来源（在这种情况下是ADA）的循证建议;因此，该系统可以克服儿科医生描述的儿童2型糖尿病筛查的许多障碍。虽然CDSS的使用并不新鲜，但其在儿科人群中的应用并不像在成人医学中那样普遍。此外，CDSS在儿童2型糖尿病筛查、诊断和管理中的应用相对较少。这项研究的具体目标是：（1）扩展和修改现有的基于计算机的决策支持系统（CHICA），以识别那些10岁或10岁以上的2型糖尿病风险增加的儿童，为儿科医生提供筛查2型糖尿病的指南，并协调病情的诊断和长期管理，以及（2）证明CHICA 2型糖尿病模块识别需要筛查2型糖尿病的儿童并促进及时诊断的可行性和有效性，条件的管理。第一阶段（目标1）侧重于CHICA系统的编程和改进，将需要12个月才能完成。第二阶段包括在四个儿科诊所进行的随机对照试验，以评估目标2。随机化将 我们假设，CDSS与ADA指南的结合将导致更好地遵守ADA推荐的筛查程序，以及更好地临床管理被确定为糖尿病前期或2型糖尿病的儿童。第二阶段将从第2年开始，持续到第4年的第2季度。第三阶段涉及统计分析和手稿准备。 公共卫生相关性：儿童和青少年中2型糖尿病发病率的增加不仅对受影响的个人，而且对整个社会和卫生系统都有相当大的长期影响，因为这种疾病的早期发作可能导致并发症的早期发作。儿科医生有独特而重要的机会来筛查2型糖尿病，并促进那些被确定为糖尿病前期的儿童改变生活方式;然而，在儿科初级保健环境中实施这些做法还远不理想。计算机决策支持系统，如我们的研究小组开发的通过计算机自动化改善儿童健康（CHICA）系统，为儿科医生筛查2型糖尿病提供了最好的希望，并为诊断为2型糖尿病或糖尿病前期的患者提供适当的临床管理。

DESCRIPTION (provided by applicant): 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 our research group - the Child Health Improvement through Computer Automation (CHICA) system. Using the CHICA system we 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 we 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. PUBLIC HEALTH RELEVANCE: 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, as earlier onset of the condition can lead to earlier onset of complications. 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. Computer decision support systems, such as the Child Health Improvement through Computer Automation (CHICA) system developed by our research group, offer the best hope to equip pediatricians to screen for type 2 diabetes and to provide appropriate clinical management to patients who are diagnosed with type 2 diabetes or pre-diabetes.