Glucose and Cholesterol Screening for Pediatric Obesity A Training for CHDP Providers Prepared by:...
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Transcript of Glucose and Cholesterol Screening for Pediatric Obesity A Training for CHDP Providers Prepared by:...
Glucose and Cholesterol Screening for Pediatric Obesity
A Training for CHDP Providers
Prepared by: The CHDP Nutrition Subcommittee
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
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
Overweight & Obese Children California children ages 2 to <5
2009
16.4 14.9 13.1 14.6 15.9
18.413.7 13.4 13.2
17
0
10
20
30
40
Hispanic White Asian Black All Groups
Per
cent
age
Overweight: 85 - <95%BMI Obese: > or = 95% BMI
2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report
Overweight & Obese Children California children ages 5 to <20 years
2009
19.1 17.2 13.8 17.6 18.4
24.519.9
13.3
21.2 23.1
0
10
20
30
40
50
Hispanic White Asian Black All Groups
Per
cent
age
Overweight: 85 - <95%BMI Obese: > or = 95% BMI2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report
Accurate Weight & Stature
BMI Percentile
Select the appropriate growth chart
Record the data
Calculate BMI
Plot measurements
Interpret plotted measurements
Boys: 2 to 20 years
BMI BMI
BMI BMI
> 99th % Severely obese
> 95th % Obese
85th to < 95th % Overweight
< 5th % Underweight
BMI % Growth Chart
Obese
Overweight
Normal*
Underweight
Lab Tests(cholesterol &
glucose)
In-depthMedical
Assessment
Note in chart:“Counsel & Follow-up”
Measurements
• Weight• Height• Age• Plot
Assessment Algorithm
+
-
*Further tests may be warranted depending
on family history
Conditions Associated with Childhood Overweight
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
Orthopedic Conditions• Accelerated Growth• Hip Disorders
Psychological Conditions• Depression/Self-Esteem• Substance Abuse• Disordered Eating• Discrimination
Pulmonary Conditions• Asthma• Sleep Apnea
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
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
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
Screening Guide
Billing Instructions
Description Code Age Reimbursement
Blood glucose – collection & analysis, or collection & handling
25 5 years through 20 years 11 months
$4.34
Blood/serum cholesterol – collection & analysis or collection & handling
26 5 years through 20 years 11 months
$4.03
Completing the PM160
25
26
Blood glucose
Use Code 25 and/or 26 ONLY if collecting the sample.
Otherwise, denote: “Sent for glucose and/or cholesterol lab.”
LaboratoriesBlood Glucose – Code 25Cholesterol – Code 26
Blood/Serum Cholesterol
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
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