Pediatric Endocrinologists Vary Widely in Diabetes Practices

Younger providers show more aggressive management in pediatric type 2 diabetes cases

WEDNESDAY, March 31 (HealthDay News) -- Pediatric endocrinologists vary widely in their management of pediatric type 2 diabetes, with younger providers likely managing the disease more aggressively, according to research published in the March issue of Diabetes Care.

Kam Wong, of Vanderbilt University in Nashville, Tenn., and colleagues analyzed data from a survey of a nationwide sample of 211 pediatric endocrinologists, which inquired about medications they prescribe, frequency of testing for diabetes care, and attitudes toward diabetes management, and posed three clinical vignettes to assess management aggressiveness.

The researchers found that concordance with monitoring guidelines ranged from 36 percent for foot care to 93 percent for blood pressure monitoring. Based on the clinical vignettes, only 34 percent were completely concordant with current treatment guidelines. Providers ages 45 or younger or who were in clinical practice less than 10 years showed more aggressive management behaviors and had greater concordance with guidelines.

"Possible reasons for the variation in testing and treatment include clinical inertia, lack of familiarity with current recommendations, pediatric endocrinologists' lack of experience with antihypertensive and cholesterol-lowering medications, lack of system-level approaches, and the current lack of rigorous scientific evidence to support aggressive medication therapy in adolescents. Additionally, clinicians may focus on glycemic control with insufficient consideration of other issues," the authors write.

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