Transcript Glucose and Cholesterol Screening for Pediatric Obesity A Training for CHDP Providers

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
Percentage
40
30
18.4
13.4
13.2
16.4
14.9
13.1
14.6
15.9
Hispanic
White
Asian
Black
All Groups
20
10
17
13.7
0
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
Percentage
50
40
30
24.5
19.9
23.1
13.3
20
10
21.2
19.1
17.2
13.8
17.6
18.4
Hispanic
White
Asian
Black
All Groups
0
Overweight: 85 - <95%BMI
Obese: > or = 95% BMI
2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report
Accurate Weight & Stature
BMI Percentile

Select the appropriate growth chart

Record the data
BMI
BMI
Boys: 2 to 20 years

Calculate BMI

Plot measurements

BMI
BMI
Interpret plotted measurements
> 99th %
Severely obese
> 95th %
Obese
85th to < 95th %
Overweight
< 5th %
Underweight
Assessment Algorithm
Obese
In-depth
Medical
Assessment
Overweight
+
Measurements
•
•
•
•
Weight
Height
Age
Plot
BMI %
Growth
Chart
Normal*
Lab Tests
(cholesterol &
glucose)
-
Underweight
*Further tests may be
warranted depending
on family history
Note in chart:
“Counsel & Follow-up”
Conditions Associated with
Childhood Overweight



Cardiovascular Conditions
• High Blood Cholesterol
• Lipid Disorders
• Hypertension (HTN)

Orthopedic Conditions
• Accelerated Growth
• Hip Disorders

Psychological Conditions
• Depression/Self-Esteem
• Substance Abuse
• Disordered Eating
• Discrimination
Endocrine Conditions
• Type 2 Diabetes
• Insulin Resistance
• Impaired Glucose Tolerance
• Menstrual Irregularities
• Polycystic Ovarian Syndrome 
Gastrointestinal Conditions
• Non-Alcoholic Fatty Liver
Disease (NAFLD)
• Gallstones
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 Management
for 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
Blood glucose –
collection &
analysis, or
collection &
handling
25
5 years
through 20
years 11
months
Blood/serum
cholesterol –
collection &
analysis or
collection &
handling
26
5 years
through 20
years 11
months
Reimbursement
$4.34
$4.03
Completing the PM160
Laboratories
Blood Glucose – Code 25
Cholesterol – Code 26
25 Blood glucose
26 Blood/Serum Cholesterol
Use Code 25 and/or 26 ONLY if
collecting the sample.
Otherwise, denote: “Sent for
glucose and/or cholesterol lab.”
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