Computer Automation for Diagnosis and Management of Childhood Type 2 Diabetes

描述（由申请人提供）：随着美国肥胖患病率的上升，2型糖尿病的患病率也在上升，这是一种典型的成人疾病。美国糖尿病协会（ADA）建议对10岁及以上有2型糖尿病存在或发展风险的儿童进行筛查。他们还建议针对血糖水平升高但尚未诊断出糖尿病的高危儿童采取初级预防措施，如改变生活方式。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远非理想。本研究的目的是利用本研究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型糖尿病危险因素、空腹血糖受损（IFG）或空腹血糖表明可能患有糖尿病的儿童。CHICA系统的最大优势之一是能够将权威来源（在本例中是《美国残疾人法》）的循证建议以易于整合到常规儿科护理中的格式加以实施；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，但它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型糖尿病的筛查、诊断和治疗中的应用研究相对较少。本研究的具体目的是：(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2型糖尿病筛查指南；(2)证明CHICA 2型糖尿病模块的可行性和有效性，以识别需要筛查的2型糖尿病儿童，并促进病情的及时诊断和管理。第一阶段（目标1）的重点是规划和加强中国国际协调中心系统，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。随机将

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.