Adherence to guidelines for youths with diabetes mellitus
Beth Waitzfelder, Catherine Pihoker, Georgeanna Klingensmith, Doug Case, Andrea Anderson, Ronny A Bell, Jean M Lawrence, Elizabeth J Mayer-Davis, Giuseppina Imperatore, Debra Standiford, Beatriz L Rodriguez, Dana Dabelea, Michael Seid, SEARCH for Diabetes in Youth Study Group, Jean M Lawrence, Kristi Reynolds, Jin-Wen Hsu, Mary Helen Black, Kim Holmquist, Harpreet S Takhar, Ann K Kershnar, David J Pettitt, Dana Dabelea, Richard F Hamman, Lisa Testaverde, Georgeanna J Klingensmith, Marian J Rewers, David Maahs, Paul Wadwa, Stephen Daniels, Kristen Nadeau, Clifford A Bloch, Carmelita Sorrelman, Alfreda Beartrack, Beatriz L Rodriguez, Beth Waitzfelder, Wilfred Fujimoto, J David Curb, Fiona Kennedy, Greg Uramoto, Sorrell Waxman, Teresa Hillier, Richard Chung, Lawrence M Dolan, Michael Seid, Elaine Urbina, Debra A Standiford, Elizabeth J Mayer-Davis, Joan Thomas, Mark Parker, Anwar Merchant, Angela D Liese, Robert R Moran, Gladys Gaillard-McBride, Deborah Lawler, Malaka Jackson, Deborah Bowlby, James Amrhein, Pam Clark, Catherine Pihoker, Maryam Afkarian, Angela Badaru, Lisa Gilliam, Irl Hirsch, Lenna L Liu, John Neff, Joyce Yi-Frazier, Beth Loots, Rebecca O'Connor, Sue Kearns, Sharla Semana, Mona Yaptangco, Carla Greenbaum, Giuseppina Imperatore, Desmond E Williams, Henry S Kahn, Bernice Moore, Gregg W Edward, Sharon H Saydah, Barbara Linder, Santica M Marcovina, Vinod P Gaur, Kathy Gadbois, Ronny Bell, Ralph D'Agostino Jr, Bettina Beech, Douglas Case, Timothy Morgan, Michelle J Naughton, Susan Moxley, Gena Hargis, Donna Kronner, Andrea Anderson, Cralen Davis, Jeanette Andrews, Jennifer W Talton, Beth Waitzfelder, Catherine Pihoker, Georgeanna Klingensmith, Doug Case, Andrea Anderson, Ronny A Bell, Jean M Lawrence, Elizabeth J Mayer-Davis, Giuseppina Imperatore, Debra Standiford, Beatriz L Rodriguez, Dana Dabelea, Michael Seid, SEARCH for Diabetes in Youth Study Group, Jean M Lawrence, Kristi Reynolds, Jin-Wen Hsu, Mary Helen Black, Kim Holmquist, Harpreet S Takhar, Ann K Kershnar, David J Pettitt, Dana Dabelea, Richard F Hamman, Lisa Testaverde, Georgeanna J Klingensmith, Marian J Rewers, David Maahs, Paul Wadwa, Stephen Daniels, Kristen Nadeau, Clifford A Bloch, Carmelita Sorrelman, Alfreda Beartrack, Beatriz L Rodriguez, Beth Waitzfelder, Wilfred Fujimoto, J David Curb, Fiona Kennedy, Greg Uramoto, Sorrell Waxman, Teresa Hillier, Richard Chung, Lawrence M Dolan, Michael Seid, Elaine Urbina, Debra A Standiford, Elizabeth J Mayer-Davis, Joan Thomas, Mark Parker, Anwar Merchant, Angela D Liese, Robert R Moran, Gladys Gaillard-McBride, Deborah Lawler, Malaka Jackson, Deborah Bowlby, James Amrhein, Pam Clark, Catherine Pihoker, Maryam Afkarian, Angela Badaru, Lisa Gilliam, Irl Hirsch, Lenna L Liu, John Neff, Joyce Yi-Frazier, Beth Loots, Rebecca O'Connor, Sue Kearns, Sharla Semana, Mona Yaptangco, Carla Greenbaum, Giuseppina Imperatore, Desmond E Williams, Henry S Kahn, Bernice Moore, Gregg W Edward, Sharon H Saydah, Barbara Linder, Santica M Marcovina, Vinod P Gaur, Kathy Gadbois, Ronny Bell, Ralph D'Agostino Jr, Bettina Beech, Douglas Case, Timothy Morgan, Michelle J Naughton, Susan Moxley, Gena Hargis, Donna Kronner, Andrea Anderson, Cralen Davis, Jeanette Andrews, Jennifer W Talton
Abstract
Objective: To describe demographic and clinical characteristics associated with self-reported receipt of tests and measurements recommended by the American Diabetes Association (ADA) for children and youths with diabetes.
Methods: The study included 1514 SEARCH for Diabetes in Youth study participants who completed a survey about diabetes care received. Quality-of-care measures were based on ADA guidelines for eye examinations and glycohemoglobin (hemoglobin A1c [HbA1c]), lipid level, microalbuminuria, and blood pressure measurements, and a composite variable of these 5 indicators was created. Multivariate logistic regression models were used to assess the association of selected demographic and clinical characteristics with the reported receipt of all recommended tests and measurements according to age and diabetes type subgroups.
Results: Overall, 95% of the participants reported having their blood pressure checked at all or most visits, 88% had lipid levels measured, 83% had kidney function tested, 68% underwent HbA1c testing, and 66% underwent an eye examination, in accordance with ADA recommendations. Participants aged 18 years or older, particularly those with type 2 diabetes, tended to have fewer tests of all kinds performed. Age and family income emerged as important correlates of overall quality of care in multivariate models; older age and lower income were associated with not meeting guidelines.
Conclusions: Although there was relatively good adherence to ADA-recommended guidelines for most indicators, efforts are needed to improve rates of HbA1c testing and eye examinations, particularly among older youths.
Source: PubMed