Computer Automation for Diagnosis and Management of Childhood Type 2 Diabetes

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 the investigators research group - the Child
Health Improvement through Computer Automation (CHICA) system. Using the CHICA system the
investigators 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 the investigators 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.

Inclusion Criteria:

- A patient's chart will be eligible for chart abstraction if the child is age 10 or
older and is a patient at one of the four clinics involved in the study.

Exclusion Criteria: