The Observatory and Fast Facts

Dec. 19, 2019
1 in 5 adolescents now living with prediabetes

Nearly 1 in 5 adolescents aged 12-18 years, and 1 in 4 young adults aged 19-34 years, are living with prediabetes, according to a new Centers for Disease Control and Prevention (CDC) study published in JAMA Pediatrics.

Prediabetes is a health condition in which blood sugar levels are higher than normal, but not yet high enough to be diagnosed as type 2 diabetes. The condition also increases the risk of developing type 2 diabetes, chronic kidney disease, heart disease, and stroke.

Monitoring the percentage of adolescents and young adults with prediabetes can help determine the future risk of type 2 diabetes. To do this, CDC researchers used data from the National Health and Nutrition Examination Survey covering the years 2005-2016.

“The prevalence of prediabetes in adolescents and young adults reinforces the critical need for effective public health strategies that promote healthy eating habits, physical activity, and stress management,” said CDC Director Robert R. Redfield, M.D. “These lifestyle behaviors can begin early in a child’s life and should continue through adolescence and adulthood to reduce onset of type 2 diabetes.”

Key study findings:

Nearly 1 in 5 (18%) adolescents (those aged 12-18) and 1 in 4 (24%) young adults (aged 19-34 years) were living with prediabetes.

  • The percentage of adolescents and young adults living with prediabetes was higher in males and participants with obesity.
  • Hispanic young adults had higher rates of prediabetes compared to white young adults.
  • Adolescents and young adults with prediabetes had significantly higher cholesterol levels, systolic blood pressure, abdominal fat and lower insulin sensitivity than those with normal glucose tolerance, which increased their risk of type 2 diabetes and other cardiovascular diseases.

Research shows that adults with prediabetes who take part in a structured lifestyle-change program, including weight management and exercise, can cut their risk of developing type 2 diabetes by 58% (71% for people over 60 years old). Participation in the CDC-led National Diabetes Prevention Program lifestyle change program can help prevent or delay type 2 diabetes in those at high risk. The program, available to those aged 18 and older, is taught by trained lifestyle coaches, and encourages healthy, whole-life changes to help participants address barriers to improved nutrition, increased physical activity and coping mechanisms for stress reduction.

Parents can also help encourage healthy eating and increased physical activity. They can aim for their children to get 60 minutes of physical activity a day.

HCV updates recommendations for identification and management of chronic Hep C — a website developed by the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America to provide up-to-date guidance on the management of hepatitis C — was recently revised to reflect important developments in the identification and management of chronic hepatitis C (HCV).

Notably, the guidance includes an important new recommendation that all adults be screened for HCV. In addition to universal screening for hepatitis C, the guidance emphasizes universal treatment.

The update includes:

  • A simplified treatment algorithm for patients without cirrhosis or with compensated cirrhosis, who have never been treated for HCV, for use by primary care providers.
  • New treatment recommendations for children ages 3-11.
  • A recommendation that patients with acute HCV be treated without a waiting period.
  • Updates to all treatment sections, including removal of less efficacious, complex, alternative regimens, and regimens no longer available in the US.
  • The update also includes new information about management of hepatitis C in patients receiving transplantation of organs from HCV-infected donors, an emerging area of the field.

“HCV has been called ‘the silent killer’ because of its ability to damage the liver while causing few or no symptoms. Identifying patients who don’t know they are infected is key to stopping the spread of the disease. Our Panel has always recommended screening high-risk populations, but several studies now demonstrate that routine, one-time HCV testing among all adults in the U.S. would likely identify a substantial number of HCV cases that are currently being missed, and that doing so would be cost-effective. This is why we now recommend universal screening of adults,” said HCV Guidance Co-Chairs, Drs. Marc G. Ghany, Kristen M. Marks, Timothy R. Morgan, and David L. Wyles.

“The good news is that once new HCV cases are identified, there are safe and effective treatments that can cure more than 95% of people. We believe that the improved testing and treatment strategies described in the Guidance will bring us closer to achieving the World Health Organization’s goal of eliminating HCV infection as a public health threat by 2030,” they added.

AAAHC toolkit and benchmarking study offer tips for latex and penicillin allergies

The Accreditation Association for Ambulatory Health Care (AAAHC) has updated its Allergy Documentation Toolkit with an overview of challenges and improvement strategies, as well as more specific information on latex and penicillin/beta-lactam allergies, to help ambulatory healthcare organizations avoid patient complications.

More than 50 million Americans suffer from allergies each year, costing the healthcare system an estimated $18 billion. Penicillin allergies are the most common drug allergy in the U.S., with a reported prevalence of 10%, while latex allergies affect 1–7% of the U.S. population. For surgical procedures, specifically, hypersensitivity reactions may affect 1 in every 358 patients. The updated toolkit covers a wide range of allergic reactions – from severe and life-threatening, to sensitivities, intolerances, idiosyncratic reactions, and side effects.

“While documentation cannot always prevent adverse reactions, how healthcare providers approach documentation can help to reduce risk,” said Naomi Kuznets, PhD, vice president and senior director of the AAAHC Institute for Quality Improvement. “Ambulatory organizations can use this resource to develop an action plan to improve allergy education and create a standard, consistent process to follow when documenting allergies.”

While the Centers for Medicare and Medicaid Services (CMS) require documentation of allergies to medications in the pre-surgical assessment, allergy information on patient charts is often incomplete or inconsistent.

As shown in the 2019 AAAHC Quality Roadmap, accreditation survey data from 2018 surveys revealed two of the most common issues in allergy documentation are allergies not being updated during each visit and an overreliance on “No Known Drug Allergies” (NKDA).

“It is best practice for providers to note any severe reactions a patient has to any type of treatment and not just to drugs,” said Kuznets. “Thorough documentation enables healthcare providers to take immediate action when a reaction occurs in the future.”

To improve allergy documentation practices, AAAHC encourages ambulatory organizations to develop an action plan centered on education, consistency, and standardization. The updated toolkit provides organizations with current research and an action plan to educate staff, achieve consistent documentation, and standardize processes, prompts, and care transitions. Complementing the revised toolkit is an allergy documentation benchmarking study set to begin in January 2020.

Virtual reality could help flu vaccination rates

Using a virtual reality (VR) simulation to show how flu spreads and its impact on others could be a way to encourage more people to get a flu vaccination, according to a study by researchers at the University of Georgia and the Oak Ridge Associated Universities in Oak Ridge, Tennessee. This is the first published study to look at immersive virtual reality as a communication tool for improving flu vaccination rates among “flu vaccine avoidant” 18- to 49-year-old adults.

“When it comes to health issues, including flu, virtual reality holds promise because it can help people see the possible effects of their decisions, such as not getting a flu vaccine,” said Glen Nowak, the principal investigator and director of the Center for Health and Risk Communication headquartered at Grady College. “In this study, we used immersive virtual reality to show people three outcomes—how if infected, they can pass flu along to others; what can happen when young children or older people get flu; and how being vaccinated helps protect the person who is vaccinated as well as others. Immersive VR increases our ability to give people a sense of what can happen if they do or don’t take a recommended action.”

The research, “Using Immersive Virtual Reality to Improve the Beliefs and Intentions of Influenza Vaccine Avoidant 18- to 49-year-olds,” was published by the journal Vaccine on Dec. 2, which falls during National Influenza Vaccination Week, Dec. 1 – 7. The research was conducted by faculty at Grady College of Journalism and Mass Communication, including faculty in Grady’s Center for Health and Risk Communication. The research was conducted with support from a grant and researchers from ORAU.

According to the Centers for Disease Control and Prevention (CDC) during the 2017-18 flu season, only 26.9% of 18- to 49-year-olds in the U.S. received a recommended annual influenza vaccination even though it is recommended for all 18- to 49-year-olds. The low current acceptance of flu vaccination makes it important to identify more persuasive ways to educate these adults about flu vaccination. The findings from this study suggest one-way virtual reality can be more effective as it can create a sense of presence or feeling like one is a part of what is happening.

  1. The 171 participants in this study self-identified as those who had not received a flu shot last year and did not plan to receive one during the 2017-18 influenza season. In the study, participants were randomly assigned to one of four groups:
  2. a five-minute virtual reality experience; a five-minute video that was identical to the VR experience but without the 3-dimensional and interactive elements;
  3. an e-pamphlet that used text and pictures from the video presented on a tablet computer; and 
  4. a control condition that only viewed the CDC’s influenza Vaccination Information Statement (VIS), which is often provided before a flu vaccine is given and describes benefits and risks. Participants in the VR, video and e-pamphlet conditions also viewed the CDC VIS before answering a series of questions regarding flu vaccination, including whether they would get a flu vaccine. 

In the VR condition, participants were provided headsets, which enabled them to vividly experience the information and events being shown as if they were in the story, and video game controllers, which enabled them to actively participate at points in the story. Compared to video or the e-pamphlet, the VR condition created a stronger perception of presence – that is, a feeling of “being there” in the story, which, in turn, increased participants’ concern about transmitting flu to others. This increased concern was associated with greater confidence that one’s flu vaccination would protect others, more positive beliefs about flu vaccine and increased intention to get a flu vaccination. Neither the e-pamphlet nor the video was able to elicit a sense of presence nor were they able to improve the impact of the VIS on the confidence, belief and intention measures.

“This study affirms there is much to be excited about when it comes to using virtual reality for heath communication,” Karen Carera, senior evaluation specialist at ORAU, said. “However, the findings suggest that for virtual reality to change beliefs and behaviors, the presentations used need to do more than deliver a story. They need to get users to feel like they are actually in the story.”