Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

For children ages 10-17, what is being done nationally to develop a diabetes prevention program (DPP) curriculum?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

no

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Children and adolescents- 10-17 years Impaired glucose tolerance (IGT) Polycystic ovarian disease (PCOS) Metabolic syndrome Morbidly obese High risk by screening

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Delay or prevent onset of Type 2 diabetes in adolescents. Delay progression of disease in adolescents.

Describe any health-related risks, side effects, or harms that you are concerned about.

Safety and efficacy of medications (metformin, actos, etc) that are approved for use in adults as diabetes prevention but not children.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Diabetes mellitus

AHRQ Priority Populations

• Children

Federal Health Care Program

None

Importance

Describe why this topic is important.

A statistically significant increase in the prevalence of type 2 diabetes among children and adolescents was found only for American Indians. However, the rising epidemic of obesity in American adolescents has the potential to contribute to a statistically significant increase in type 2 diabetes in this population as well.

Within the Indian Health Service, health care providers want to be able to offer their at-risk pediatric population additional preventative measures (lifestyle, medication, etc) in a systematic way (diabetes prevention program (DPP) beyond the current weight management programs that primarily target obesity. Results from this study could lead to site demonstrations/pilot projects that could provide information valuable to the general population.

There is a need for adolescent DPP's in minority populations, in particular, to include clinical programming that bundles screening, assessment and treatment (to include pharmacotherapy if safe/effective) for this population.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

No USPSTF guidelines for screening for diabetes under children and adolescent recommendations. Regarding NICE Guidelines, only adults- preventing pre-diabetes in adults and preventing progression from pre-diabetes.

Outcomes from a culturally tailored diabetes prevention program in Hispanic families from a low-income school: Horton Hawks Stay Healthy (HHSH). Diabetes Educ. 2010 Sep-Oct; 36(5): 784-92. Epub 2010 July 22.

Metabolic syndrome: identifying the risk factors.

J Pediatr (Rio J). 2007 Nov; 83 (5 Suppl): S204-8.

Researching Effective Strategies to Improve Insulin Sensitivity in Children and Teenagers - RESIST.

A randomised control trial investigating the effects of two different diets on insulin sensitivity in young BMC Public Health. 2010 Sep 25; 10: 575

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

no

If yes, please explain:

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

Describe the timeframe in which an answer to your question is needed.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Are you making a suggestion as an individual or on behalf of an organization?

Please tell us how you heard about the Effective Health Care Program