Use of glycosylated hemoglobin increases diabetes screening for at-risk adolescents in primary care settings.

OBJECTIVE: To examine rates of diabetes screening in obese adolescents in an ethnically diverse primary care health care system before and after an internal recommendation to use HbA1c-based screening. RESEARCH DESIGN AND METHODS: Adolescents 12-18-years old with BMI > 95% were identified through electronic medical record review during two 18-month periods in 8 community health clinics and 13 school-based health centers: period 1 (P1, 19 April 2008 to 19 October 2009) and period 2 (P2, 3 May 2010 to 3 November 2011). Testing for diabetes in the 2 yr preceding the most recently elevated BMI was reviewed. RESULTS: A total of 2870 obese adolescents were identified in P1 and 3940 in P2. Ethnicity was primarily Hispanic, with smaller populations of Black and White youth. The percent of obese teens screened for diabetes increased from 40% in P1 to 47% in P2. Use of HbA1c increased 493% during P2. Older teens (>15 yr), those seen during P2, and those with BMI ≥ 30 kg/m2 were more likely to be screened. Record review confirmed equal rates of type 2 diabetes in the two periods: 8 incident (0.7%) cases in P1 and 13 (0.7%) in P2. CONCLUSIONS: The use of HbA1c, a non-fasting and logistically simpler test, was associated with increased diabetes screening in primary care. The percentage of screened patients with confirmed type 2 diabetes remained unchanged. Thus, despite potential pitfalls, the use of HbA1c for screening appears to be as successful as previous approaches in identifying adolescents with diabetes.

Controlled pilot study of the effects of neuromuscular therapy in patients with Parkinson's disease.

The objectives of this study is to examine the effects of neuromuscular therapy (NMT) on motor and nonmotor symptoms in Parkinson's disease (PD). Thirty-six subjects with PD were randomly assigned to NMT or music relaxation (MR, or active control). Subjects received treatment twice a week for 4 weeks. Testing was conducted at baseline, after final treatment, and 8 days after final treatment. Primary outcome measures were the Motor subscale of the United Parkinson Disease Rating Scale (UPDRS) and the Clinical Global Impression scale (CGI-Change). Secondary outcome measures included a PD-specific quality of life scale (PDQ-39), quantitative measures of motor function, and severity scales for anxiety and depression symptoms. NMT resulted in a significant and sustained improvement in the Motor subscale of the UPDRS (P < or = 0.0001), most notable in the tremor scores. Also improved 1 week after the last treatment were the CGI scores (P = 0.007) and the finger-tapping speed (P = 0.001). The MR active control group had a slight improvement in tremor but evidenced no other change in motor function. Both groups exhibited a modest improvement in quality of life immediately after the last treatment. This effect was sustained for 8 days only in the MR group. In the nonmotor domains, the MR group evidenced improvements in mood (P = 0.001) and anxiety (P = 0.002), whereas NMT had no effect on mood (P = 0.09), and its initial effect on anxiety (P = 0.0009) dissipated after 8 days (P = 0.40). Group differences for UPDRS motor score and patient CGI-Change were superior in the NMT compared to the MR group. There was no group difference in PDQ-39 scores or in nonmotor measures. The findings suggest that NMT can improve motor and selected nonmotor symptoms in PD and that this effect is more durable for the motor symptoms. The results of this pilot study warrant larger controlled studies to examine dose range, durability, and mechanisms of NMT in PD function.