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      Pediatric Endocrinologists' Management of Children With Type 2 Diabetes

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          Abstract

          OBJECTIVE

          To understand physician behaviors and attitudes in managing children with type 2 diabetes.

          RESEARCH DESIGN AND METHODS

          A survey was mailed to a nationwide sample of pediatric endocrinologists (PEs).

          RESULTS

          A total of 40% of PEs surveyed responded (211 of 527). Concordance with current monitoring guidelines varied widely, ranging from 36% (foot care) to 93% (blood pressure monitoring). Given clinical vignettes addressing hyperlipidemia, hypertension, and microalbuminuria, only 34% of PEs were fully concordant with current treatment guidelines. Reported barriers included concerns about patient adherence, insufficient scientific evidence about treatment, and lack of familiarity with current recommendations. Providers aged ≤45 years or in clinical practice <10 years reported significantly more aggressive management behaviors and had higher concordance with guidelines.

          CONCLUSIONS

          Screening and management of pediatric type 2 diabetes varied widely among PEs, suggesting opportunities for quality improvement. More aggressive management of type 2 diabetes among younger providers may be related to recent training when type 2 diabetes was more common.

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          Clinical inertia.

          Clive Phillips, Andrew C. Barnes, Joseph Doyle … (2001)
          Medicine has traditionally focused on relieving patient symptoms. However, in developed countries, maintaining good health increasingly involves management of such problems as hypertension, dyslipidemia, and diabetes, which often have no symptoms. Moreover, abnormal blood pressure, lipid, and glucose values are generally sufficient to warrant treatment without further diagnostic maneuvers. Limitations in managing such problems are often due to clinical inertia-failure of health care providers to initiate or intensify therapy when indicated. Clinical inertia is due to at least three problems: overestimation of care provided; use of "soft" reasons to avoid intensification of therapy; and lack of education, training, and practice organization aimed at achieving therapeutic goals. Strategies to overcome clinical inertia must focus on medical students, residents, and practicing physicians. Revised education programs should lead to assimilation of three concepts: the benefits of treating to therapeutic targets, the practical complexity of treating to target for different disorders, and the need to structure routine practice to facilitate effective management of disorders for which resolution of patient symptoms is not sufficient to guide care. Physicians will need to build into their practice a system of reminders and performance feedback to ensure necessary care.
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            Assessment of chronic illness care (ACIC): a practical tool to measure quality improvement.

            Amy Bonomi, Edward H Wagner, Russell E. Glasgow … (2002)
            To describe initial testing of the Assessment of Chronic Illness Care (ACIC), a practical quality-improvement tool to help organizations evaluate the strengths and weaknesses of their delivery of care for chronic illness in six areas: community linkages, self-management support, decision support, delivery system design, information systems, and organization of care. (1) Pre-post, self-report ACIC data from organizational teams enrolled in 13-month quality-improvement collaboratives focused on care for chronic illness; (2) independent faculty ratings of team progress at the end of collaborative. Teams completed the ACIC at the beginning and end of the collaborative using a consensus format that produced average ratings of their system's approach to delivering care for the targeted chronic condition. Average ACIC subscale scores (ranging from 0 to 11, with 11 representing optimal care) for teams across all four collaboratives were obtained to indicate how teams rated their care for chronic illness before beginning improvement work. Paired t-tests were used to evaluate the sensitivity. of the ACIC to detect system improvements for teams in two (of four) collaboratives focused on care for diabetes and congestive heart failure (CHF). Pearson correlations between the ACIC subscale scores and a faculty rating of team performance were also obtained. Average baseline scores across all teams enrolled at the beginning of the collaboratives ranged from 4.36 (information systems) to 6.42 (organization of care), indicating basic to good care for chronic illness. All six ACIC subscale scores were responsive to system improvements diabetes and CHF teams made over the course of the collaboratives. The most substantial improvements were seen in decision support, delivery system design, and information systems. CHF teams had particularly high scores in self-management support at the completion of the collaborative. Pearson correlations between the ACIC subscales and the faculty rating ranged from .28 to .52. These results and feedback from teams suggest that the ACIC is responsive to health care quality-improvement efforts and may be a useful tool to guide quality improvement in chronic illness care and to track progress over time.
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              Type 2 diabetes in children and adolescents. American Diabetes Association.

              AD Association, Psychiatric Association American (2000)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Diabetes Care
                Journal ID (hwp): diacare
                Journal ID (pmc): dcare
                Journal ID (publisher-id): Diabetes Care
                Title: Diabetes Care
                Publisher: American Diabetes Association
                ISSN (Print): 0149-5992
                ISSN (Electronic): 1935-5548
                Publication date (Print): March 2010
                Publication date (Electronic): 10 December 2009
                Volume: 33
                Issue: 3
                Pages: 512-514
                Affiliations
                [1] 1Departments of Medicine and Pediatrics, Vanderbilt University, Nashville, Tennessee;
                [2] 2Vanderbilt Eskind Diabetes Clinic, Vanderbilt University, Nashville, Tennessee;
                [3] 3Vanderbilt University School of Nursing, Nashville, Tennessee;
                [4] 4Department of Psychology, Vanderbilt University, Nashville, Tennessee.
                Author notes
                Corresponding author: Russell Rothman, russell.rothman@ 123456vanderbilt.edu .
                Article
                Publisher ID: 1333
                DOI: 10.2337/dc09-1333
                PMC ID: 2827499
                PubMed ID: 20007947
                SO-VID: 47092e84-399f-40ba-8cae-4f9c7493ec4e
                Copyright © © 2010 by the American Diabetes Association.
                License:

                Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

                History
                Date received : 21 July 2009
                Date accepted : 17 November 2009
                Funding
                Funded by: National Institutes of Health
                Award ID: P60 DK020593-28
                Award ID: K23 DK065294
                Categories
                Subject: Original Research
                Subject: Clinical Care/Education/Nutrition/Psychosocial Research

                ScienceOpen disciplines: Endocrinology & Diabetes
                Data availability:
                ScienceOpen disciplines: Endocrinology & Diabetes

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