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Glucose and Cholesterol Screening for Pediatric Obesity

Enhance care quality by screening for diabetes & heart risk factors in obese youths. Lab results guide early intervention/referral.

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Glucose and Cholesterol Screening for Pediatric Obesity

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  1. Glucose and Cholesterol Screening for Pediatric Obesity A Training for CHDP Providers Prepared by: The CHDP Nutrition Subcommittee

  2. Goal • To ensure that children and adolescents with BMI ≥ 85th percentile, as well as those who are at risk but not overweight, are screened for the most common medical conditions associated with childhood overweight

  3. Agenda • Review the medical conditions associated with pediatric overweight/obesity • Summarize the risk factors for complications of pediatric overweight/obesity that need to be identified as part of a health assessment • Clarify the guidelines as described in CHDP Provider Information Notices 05-16 and 05-22

  4. Overweight & Obese ChildrenCalifornia children ages 2 to <5 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report

  5. Overweight & Obese ChildrenCalifornia children ages 5 to <20 years 2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report

  6. Accurate Weight & Stature

  7. BMI BMI Boys: 2 to 20 years BMI BMI BMI Percentile • Select the appropriate growth chart • Record the data • Calculate BMI • Plot measurements • Interpret plotted measurements >99th % Severely obese > 95th % Obese 85th to < 95th % Overweight < 5th % Underweight

  8. Assessment Algorithm In-depth Medical Assessment • Measurements • Weight • Height • Age • Plot Obese Overweight BMI % Growth Chart + Lab Tests (cholesterol & glucose) Normal* Underweight - Note in chart: “Counsel & Follow-up” *Further tests may be warranted depending on family history

  9. Conditions Associated with Childhood Overweight • Orthopedic Conditions • Accelerated Growth • Hip Disorders • Psychological Conditions • Depression/Self-Esteem • Substance Abuse • Disordered Eating • Discrimination • Pulmonary Conditions • Asthma • Sleep Apnea • Cardiovascular Conditions • High Blood Cholesterol • Lipid Disorders • Hypertension (HTN) • Endocrine Conditions • Type 2 Diabetes • Insulin Resistance • Impaired Glucose Tolerance • Menstrual Irregularities • Polycystic Ovarian Syndrome • Gastrointestinal Conditions • Non-Alcoholic Fatty Liver Disease (NAFLD) • Gallstones

  10. Recommended Screening for Children ≥ 5 Years of Age Screen for both cholesterol & glucose* if BMI ≥ 85th % AND two of the following risk factors (may be repeated as medically necessary): • BMI ≥ 95th % • Family history of diabetes • Black, Hispanic, American Indian, Asian, Pacific Islander, Native Alaskan • One of the following: acanthosis nigricans, HTN, dyslipidemia or polycystic ovarian syndrome • Less than 30 minutes activity/day or consistently unbalanced diet *This training is not intended to cover all aspects of type 1 or type 2 diabetes

  11. Recommended Screening for Children ≥ 5 Years of Age Screen for cholesterol if one of the following risk factors is present (may be repeated as medically necessary): • One parent or grandparent had heart/vascular disease, heart attack, heart death, heart surgery or stroke at ≤ 55 years of age* • One parent has a cholesterol level ≥ 240 mg/dl* *Family history may not be available for all children

  12. Referral & Care Managementfor Abnormal Test Results • Fasting glucose ≥ 126 mg/dl (elevated): counsel & repeat test, endocrinology referral and/or CCS referral* • Cholesterol > 170 - < 200 mg/dl (borderline): counsel & repeat test in one year* • Cholesterol ≥ 200 mg/dl (elevated): cardiac referral and/or CCS referral* *Clinical judgment should be used

  13. Screening Guide

  14. Billing Instructions

  15. Laboratories Blood Glucose – Code 25 Cholesterol – Code 26 Use Code 25 and/or 26 ONLY if collecting the sample. Otherwise, denote: “Sent for glucose and/or cholesterol lab.” 25 Blood glucose 26 Blood/Serum Cholesterol Completing the PM160

  16. Resources • For the AMA 2007 Expert Committee Recommendations, go to: www.ama-assn.org/ama/pub/category/11759.html • For the AAP policy on lipid screening and heart health in children, go to: www.aap.org/advocacy/releases/july08lipidscreening.htm • American Diabetes Association: Type 2 Diabetes in Children and Adolescents. Pediatrics 105:671-680, 2000

  17. Summary • Lab screening is necessary to provide quality care for children who are overweight/obese • Glucose and cholesterol screening facilitates early identification of children who are at risk for diabetes and cardiovascular disease • Abnormal lab results can help guide providers to initiate early intervention and/or referral to treatment

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