Computer Automation for Diagnosis and Management of Childhood Type 2 Diabetes

描述(申请人提供)：随着美国肥胖症患病率的上升，2型糖尿病的患病率也在上升，这是一种通常与成年人有关的疾病。美国糖尿病协会(ADA)建议对10岁或10岁以上的儿童进行筛查，这些儿童存在或发展成2型糖尿病的风险很大。他们还建议，初级预防措施，如改变生活方式，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也远不理想。这项研究的目的是在儿科初级保健实践中使用由我们的研究小组-通过计算机自动化改善儿童健康(CHICA)系统开发的计算机决策支持系统(CDSS)来实施2型糖尿病的ADA筛查指南。使用CHICA系统，我们还将为儿科医生实施临床管理提示，以照顾有2型糖尿病危险因素、空腹血糖受损(IFG)或空腹血糖提示可能患有糖尿病的儿童。CHICA系统的最大优势之一是它能够执行来自权威来源(在这种情况下是ADA)的循证建议，这种建议的形式很容易融入常规的儿科护理；因此，该系统可以克服儿科医生所描述的在儿童2型糖尿病筛查方面的许多障碍。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型糖尿病筛查、诊断和治疗中的应用相对较少。这项研究的具体目的是：(1)扩展和修改现有的计算机化决策支持系统(CHICA)，以确定那些10岁及以上有更高风险患2型糖尿病的儿童，为儿科医生提供筛查2型糖尿病的指南，并协调该疾病的诊断和长期管理；(2)展示CHICA 2型糖尿病模块对于识别那些需要进行2型糖尿病筛查的儿童的可行性和有效性，促进对该疾病的及时诊断和管理。第一阶段(目标1)侧重于对中非合作框架系统进行方案拟订和改进，将需要12个月的时间完成。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指南相结合将导致更好地遵守ADA推荐的筛查程序，以及对被确认为糖尿病前期或2型糖尿病的儿童进行更好的临床管理。第二阶段将从第二年开始，一直持续到第四年第二季度。第三阶段涉及统计分析和手稿准备。

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.