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Very poor follow-thu with vitamin D testing and supplementation of obese children – June 2013


Endocr Rev, Vol. 34 (03_Meeting Abstracts): SAT-694
Copyright © 2013 by The Endocrine Society
Zohreh Shoar, MD MPH1, Yasmin Shoar2 and Francesco De Luca, MD1
1 St Christopher's Hospital for Children, Philadelphia,PA
2 St. Christopher's Hospital for Children, Philadelphia,PA

Background: The 2011 Endocrine Society’s Clinical Practice Guidelines on Evaluation, Treatment, and Prevention of vitamin D deficiency considers all obese children to be at risk for vitamin D deficiency and recommends screening and treatment to maintain 25-hydroxy vitamin D [25(OH) D] levels between 30 and 100 ng/mL. Yet, it is unclear how consistently these guidelines are followed by medical providers who take care of obese children.

In our Center for the Metabolic Disease at St. Christopher’s Hospital for Children, there was no universal plan to screen and/or treat vitamin D deficiency in obese children. The objective of the present study was to improve the rate of vitamin D screening in a 6-month period during which an educational program was targeted to the medical providers who cared for obese children.

Methods: The educational program ("intervention") consisted of:

  • 1) a PowerPoint presentation given to all medical providers;
  • 2) a flyer summarizing the Endocrine Society Guidelines posted in the providers’ clinic work area; and
  • 3) periodical emails sent to the providers during a 6-month period, reminding them of the guidelines.

We defined Vitamin D deficiency or insufficiency based on 25(OH) D levels (lower than 20 ng/mL or between 20 and 30 ng/mL, respectively). Before implementing the program, we reviewed the charts of all new obese patients seen at our center from March through August 2011 ("pre-intervention") and collected the data regarding the request for serum 25 (OH) D levels and the decision to treat those with vitamin D deficiency. We excluded patients who had laboratory values indicating vitamin D deficiency at the initial visit and those for whom we did not request any laboratory work up. At the end of the 6-month intervention (September 2011 through February 2012), we collected and analyzed data from new obese patients regarding the request for 25(OH) D and decision for treatment during the intervention period.

Results: During the pre-intervention period, serum 25(OH) D was requested in 10 of 40 patients (25%). In eight patients vitamin D was either deficient or insufficient (4 patients per sub-group); 2 patients did not obtain the lab work. Treatment was recommended for all 4 vitamin D deficient and 2 of 4 vitamin D insufficient children.
During the intervention, 25(OH) D was requested in 99 out of 133 patients (74%). Fifty-one children were found with vitamin D deficiency (64%) and 24 with vitamin D insufficiency (30%). 19 patients did not obtain the lab test and 5 patients (6%) had sufficient vitamin D levels. Among 75 patients with deficient or insufficient 25(OH) D levels, 51 were treated (68%).

Conclusion: Our study indicates that a more structured reinforcement of the Endocrine Society guidelines is beneficial to improve detection and treatment of vitamin D deficiency in obese children. Further studies are needed to determine whether such effect will be sustained overtime.

Summary by VitaminDWiki – when they were trying to follow the guidelines

  • Tests were requested of only 74% of patients
  • Tests actually performed for just 60% of patients
  • Only 6% of those tested did not need treatment (that is, had >30 ng of vitamin D)
  • Vitamin D actually prescribed for just 38% of patients (51)
  • Does not state how many of the patients complied (took the prescription)
    I assume that only about 20% actually got the vitamin D, while the goal should have been 94% = 100%-6% who had enough vitamin D
    Assumption is based on a dozen previous studies showing % which actually got a prescription then % of those who actually took the prescription
  • Does not appear to have used a high dose to restore vitamin D levels quickly
  • Does not indicate what % of patients actually had their vitamin D levels restored to normal

See also VitaminDWiki