Screening for Impaired Glucose Tolerance in the Adolescent Population

Impaired glucose tolerance (IGT) occurs when the body's cells are not able to effectively utilize available insulin. As a result, plasma glucose levels are elevated, but not considered high enough for a diagnosis of diabetes. This occurs in about 16% of the adolescent population in the United States. When obesity is taken into account, this prevalence increases to 25%. IGT does not often present with any symptoms, so it is likely to go undiagnosed until further complications arise. IGT leads to the development of type 2 diabetes mellitus and multiple other related complications that have the potential to lead to significant health deterioration later in life. Screening guidelines for IGT are available from the American Diabetes Association. Literature shows, however, that inadequate screening is being performed in the primary care setting. Children and adolescents meeting the criteria for screening are being screened less than 50% of the time. The incorporation of adequate screening in primary care is essential to reducing the transition of IGT to type 2 diabetes. Early detection and treatment of IGT can delay or even prevent the development of further complications. Literature names the major barrier to implementation and adherence to current guidelines as a lack of knowledge. The purpose of this project was to educate primary care providers and evaluate adherence to current screening guidelines. The objectives of this project were to assess current provider adherence to IGT screening guidelines, to educate providers on the current guidelines of IGT in adolescents, to evaluate practice change in screening adherence after an educational in-service, and to disseminate the findings of the project to a wider audience. This project was implemented at a community family practice clinic. A baseline retrospective chart review was performed. The adherence rate was calculated as the percentage of patients meeting screening criteria who were screened appropriately. A clinical staff educational in-service was given on IGT screening guidelines, results of the baseline chart review, and strategies for improvement. Copies of an algorithm illustrating current guidelines were provided for each exam room. A pre- and post-questionnaire was provided to evaluate knowledge base and motivation. A follow-up chart review was performed 2 months after the in-service to evaluate practice change. To disseminate the project findings, a clinical poster abstract was created and submitted to the Utah Nurses Association Conference organizers for the 2014 conference. The pre- and post-in-service questionnaires showed an increased understanding of current screening guidelines. Unfortunately, it was found that not all of the relevant information needed to assess for screening qualification was being gathered. Therefore, it was difficult to determine any eligibility for screening in the baseline review. An updated health history form was reviewed and implemented and eligibility could be determined at the follow-up chart review. No one was again screened at the follow-up chart review due to providers' concerns about insurance coverage. Additional research and clarification provided the clinic with coding and insurance coverage information. Further research and assistance is indicated to address other barriers to implementation of the current screening guidelines to aide in improvement of adherence rates.