As obesity has become much more prevalent in recent years, so too has Type 2 diabetes (T2D). Although the American Diabetes Association, among other organizations, has recommended screening for adolescents with risk factors, too few pediatricians have adopted this into practice.
A recent study conducted by researchers in the Indiana University School of Medicine Department of Pediatrics examined whether the use of a clinical decision support system could make that better. The Child Health Improvement Through Computer Automation (CHICA) system, developed at IU School of Medicine, has been shown in previous studies to improve adherence to guideline-based care for developmental screening, asthma care, smoking cessation, ADHD diagnosis and management, and more. This study created a Type 2 diabetes screening module to see if the system could improve pediatricians’ care of children at risk for T2D.
This was an NIH-funded cluster-randomized clinical trial that included patients from four primary care pediatric clinics in the Indianapolis area. All children and adolescents 10 years of age or older were eligible for the trial, which ran over four years.
The researchers found that the T2D module significantly improved care. Records were reviewed for more than 1,300 children. Almost 50 percent of these children had a body mass index at the 85th percentile or higher, meaning that they were at risk for being overweight. More than 40 percent of all children met the criteria for T2D screening.
In the intervention clinics, more than 31 percent of children who met criteria underwent that screening process, which involves some blood tests. In the control clinics, though, only 9 percent of children underwent screening. Moreover, more children attended a scheduled follow-up appointment with the CHICA system than without it (29 percent versus 19 percent).
Although more work needs to be done to improve how well pediatricians adhere to guidelines with respect to T2D screening and diagnosis, this represented a significant improvement over usual care. This study shows that the use of a computerized clinical decision support system that automated the identification and screening of kids at a high risk for T2D can help to overcome many of the barriers to that process. It also shows that the CHICA system continues to hold promise for improving the care of children in Indianapolis and elsewhere.
