Semester

Summer

Date of Graduation

2023

Document Type

Problem/Project Report

Degree Type

DNP

College

School of Nursing

Department

Not Listed

Committee Chair

Kendra Barker

Committee Co-Chair

Stacy Huber

Committee Member

Jessica Workman

Abstract

Abstract

The Creation of an Adolescent Prediabetes Screening Protocol to Help with Early Prediabetes Identification

Brittany Parker, MSN, APRN, FNP-C

Problem: The American Diabetes Association (ADA) and the International Society for Pediatric and Adolescent Diabetes (ISPAD) recommend screening for prediabetes and type 2 diabetes mellitus (T2DM) in high-risk asymptomatic children and adolescents after puberty or at ten years of age, whichever occurs first. However, this recommendation has not been formally recognized by the state of West Virginia for integration into wellness child exam requirements, nor has it been made common practice in many primary care clinics to be flagged as an issue for children meeting the high-risk criteria.

Background: The childhood obesity epidemic has been increasing at an alarming rate, with a significant increase in the prevalence of T2DM. ADA guidelines recommend screening for T2DM and prediabetes in all asymptomatic children and adolescents ages ten and older who are considered to be overweight, obese, or have at least one risk-factor such as a family history or sedentary lifestyle.

Literature Review to Support Planned Intervention: Approximately 20% of adolescents between the ages of 12-18 have prediabetes, with research suggesting that the prevalence of T2DM among the adolescent population will quadruple by the year 2050. Recognizing risk factors and screening for prediabetes is essential to identify the condition and initiate treatment to reduce progression and complications of the disease.

Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to develop and implement a screening protocol for adolescents with risk factors for prediabetes or type 2 diabetes and increase DEAP referrals for adolescent aged patient’s seeking care for any encounter at the FQHC.

Methods: The practice change occurred with the creation of a formal screening protocol for prediabetes in the adolescent population that was implemented as a pilot study over 3 months.

Plan for Implementation: For this project, adolescent patients with risk factors were screened during all visits, not just annual well-visits. An educational intervention of an adolescent prediabetes screening learning module presentation was provided to 27 medical providers.

Plan for Evaluation: This DNP project was evaluated using a Logic Model. The first input was the staff education, with an output measured by a post-education electronic Qualtrics survey to assess the feasibility the proposed protocol. Additional outputs assessed include the number of adolescent patients seen in the clinic during a 3-month time period that met the risk screening criteria, that received screening measures, and that were identified with prediabetes as compared to these outputs in a previous baseline year.

Results: A total of 81.25% of the participating providers who took the feasibility survey indicated that they felt the information provided within the module was informative to their practice, and 75% indicated that this screening protocol seemed adaptable for the current workflow encounters with the adolescent population. Unfortunately, the percentage for screening at-risk adolescent-aged patients for prediabetes did not increase. There was a total screening percentage of 10% in February, 14.14% in March, and a 9.375% screening rate in April.

Conclusion: While adolescent prediabetes screening levels did not increase, providers at the clinic are supportive of the practice change to better recognize and manage prediabetes and T2DM in adolescence. A planned revision for sustainability after project analysis is to implement this intervention during scheduled well-child annual examinations instead of attempting to perform the screening at every single patient visit.

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