john hopkins type 2 diabetes research

Screening for type 2 diabetes and dysglycemia

Research output : Contribution to journal › Article › peer-review

Type 2 diabetes mellitus (T2DM) and dysglycemia (impaired glucose tolerance and/or impaired fasting glucose) are increasingly contributing to the global burden of diseases. The authors reviewed the published literature to critically evaluate the evidence on screening for both conditions and to identify the gaps in current understanding. Acceptable, relatively simple, and accurate tools can be used to screen for both T2DM and dysglycemia. Lifestyle modification and/or medication (e.g., metformin) are cost-effective in reducing the incidence of T2DM. However, their application is not yet routine practice. It is unclear whether diabetes-prevention strategies, which influence cardiovascular risk favorably, will also prevent diabetic vascular complications. Cardioprotective therapies, which are cost-effective in preventing complications in conventionally diagnosed T2DM, can be used in screen-detected diabetes, but the magnitude of their effects is unknown. Economic modeling suggests that screening for both T2DM and dysglycemia may be cost-effective, although empirical data on tangible benefits in preventing complications or death are lacking. Screening for T2DM is psychologically unharmful, but the specific impact of attributing the label of dysglycemia remains uncertain. Addressing these gaps will inform the development of a screening policy for T2DM and dysglycemia within a holistic diabetes prevention and control framework combining secondary and high-risk primary prevention strategies.

• diabetes mellitus type 2
• glucose intolerance
• mass screening
• prediabetic state

ASJC Scopus subject areas

• Epidemiology

Access to Document

• 10.1093/epirev/mxq020

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• Link to publication in Scopus
• Link to the citations in Scopus

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• Type 2 Diabetes Mellitus Medicine & Life Sciences 100%
• Costs and Cost Analysis Medicine & Life Sciences 35%
• Global Burden of Disease Medicine & Life Sciences 25%
• Diabetic Angiopathies Medicine & Life Sciences 25%
• Metformin Medicine & Life Sciences 20%
• Glucose Intolerance Medicine & Life Sciences 20%
• Primary Prevention Medicine & Life Sciences 19%
• Life Style Medicine & Life Sciences 15%

T1 - Screening for type 2 diabetes and dysglycemia

AU - Echouffo-Tcheugui, Justin B.

AU - Ali, Mohammed K.

AU - Griffin, Simon J.

AU - Narayan, K. M.Venkat

N1 - Funding Information: Justin B. Echouffo-Tcheugui was funded by a Gates Cambridge Trust scholarship when this review was conducted. Simon J. Griffin receives support from the Department of Health NIHR Programme Grant funding scheme (RP-PG-0606-1259).

PY - 2011/7

Y1 - 2011/7

N2 - Type 2 diabetes mellitus (T2DM) and dysglycemia (impaired glucose tolerance and/or impaired fasting glucose) are increasingly contributing to the global burden of diseases. The authors reviewed the published literature to critically evaluate the evidence on screening for both conditions and to identify the gaps in current understanding. Acceptable, relatively simple, and accurate tools can be used to screen for both T2DM and dysglycemia. Lifestyle modification and/or medication (e.g., metformin) are cost-effective in reducing the incidence of T2DM. However, their application is not yet routine practice. It is unclear whether diabetes-prevention strategies, which influence cardiovascular risk favorably, will also prevent diabetic vascular complications. Cardioprotective therapies, which are cost-effective in preventing complications in conventionally diagnosed T2DM, can be used in screen-detected diabetes, but the magnitude of their effects is unknown. Economic modeling suggests that screening for both T2DM and dysglycemia may be cost-effective, although empirical data on tangible benefits in preventing complications or death are lacking. Screening for T2DM is psychologically unharmful, but the specific impact of attributing the label of dysglycemia remains uncertain. Addressing these gaps will inform the development of a screening policy for T2DM and dysglycemia within a holistic diabetes prevention and control framework combining secondary and high-risk primary prevention strategies.

AB - Type 2 diabetes mellitus (T2DM) and dysglycemia (impaired glucose tolerance and/or impaired fasting glucose) are increasingly contributing to the global burden of diseases. The authors reviewed the published literature to critically evaluate the evidence on screening for both conditions and to identify the gaps in current understanding. Acceptable, relatively simple, and accurate tools can be used to screen for both T2DM and dysglycemia. Lifestyle modification and/or medication (e.g., metformin) are cost-effective in reducing the incidence of T2DM. However, their application is not yet routine practice. It is unclear whether diabetes-prevention strategies, which influence cardiovascular risk favorably, will also prevent diabetic vascular complications. Cardioprotective therapies, which are cost-effective in preventing complications in conventionally diagnosed T2DM, can be used in screen-detected diabetes, but the magnitude of their effects is unknown. Economic modeling suggests that screening for both T2DM and dysglycemia may be cost-effective, although empirical data on tangible benefits in preventing complications or death are lacking. Screening for T2DM is psychologically unharmful, but the specific impact of attributing the label of dysglycemia remains uncertain. Addressing these gaps will inform the development of a screening policy for T2DM and dysglycemia within a holistic diabetes prevention and control framework combining secondary and high-risk primary prevention strategies.

KW - diabetes mellitus type 2

KW - glucose intolerance

KW - mass screening

KW - prediabetic state

UR - http://www.scopus.com/inward/record.url?scp=79960542955&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79960542955&partnerID=8YFLogxK

U2 - 10.1093/epirev/mxq020

DO - 10.1093/epirev/mxq020

M3 - Article

C2 - 21624961

AN - SCOPUS:79960542955

SN - 0193-936X

JO - Epidemiologic reviews

JF - Epidemiologic reviews

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Epidemiology of Type 2 Diabetes

Prevalence of type 2 diabetes in the u.s..

• Approximately 30.3 million people (23 million diagnosed, 7.2 million undiagnosed) have diabetes. In 2015, 9.4% of the U.S. population had a diagnosis of diabetes.
• Approximately 84.1 million adults aged 18 years or older had prediabetes in 2015, based on their fasting glucose or A1C level.
• In 2015, among U.S. adults aged 18 years or older, there was an estimated 1.5 million new cases of diabetes.
• One in four older adults have diabetes. Nearly three-quarters of adults aged 65 years or older had diabetes or pre-diabetes . [9]
• In 2013-2015, the overall prevalence was higher among American Indians/Alaska Natives (15.1%), non-Hispanic blacks (12.7%), and those of Hispanic ethnicity (12.1%) than among non-Hispanic whites (7.4%) and Asians (8.0%).
• The prevalence of diagnosed diabetes in adults greater than 18 years old continues to increase from 7.3% in 2005 to 8.7% in 2015.
• References include: [13] [8]

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HCC Researchers Outline Guidance for Treating Youth with Type 2 Diabetes

According to researchers, the number of children with type 2 diabetes has increased worldwide, and experts call it a growing epidemic. The condition can quickly progress into a serious disease for children with high complication rates, and it disproportionately affects youth from minority or low-income backgrounds.

In  an article  in  The   Journal of Clinical Endocrinology & Metabolism , a group of Johns Hopkins Children’s Center researchers, including pediatric endocrinologists  Sheela Magge  and  Talia Hitt , examine patient case studies and provide clinical guidance for both pediatric and adult practitioners to treat type 2 diabetes aggressively and reduce early complication rates that could continue or worsen as patients enter adulthood.

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Precision subclassification of type 2 diabetes: a systematic review

Collaborators.

• ADA/EASD PMDI : Deirdre K Tobias ,  Jordi Merino ,  Abrar Ahmad ,  Catherine Aiken ,  Jamie L Benham ,  Dhanasekaran Bodhini ,  Amy L Clark ,  Kevin Colclough ,  Rosa Corcoy ,  Sara J Cromer ,  Jamie L Felton ,  Ellen C Francis ,  Pieter Gillard ,  Véronique Gingras ,  Romy Gaillard ,  Eram Haider ,  Alice Hughes ,  Jennifer M Ikle ,  Laura M Jacobsen ,  Anna R Kahkoska ,  Jarno L T Kettunen ,  Raymond J Kreienkamp ,  Lee-Ling Lim ,  Jonna M E Männistö ,  Robert Massey ,  Niamh-Maire Mclennan ,  Rachel G Miller ,  Mario Luca Morieri ,  Jasper Most ,  Rochelle N Naylor ,  Bige Ozkan ,  Kashyap Amratlal Patel ,  Scott J Pilla ,  Sridaran Raghaven ,  Martin Schön ,  Zhila Semnani-Azad ,  Magdalena Sevilla-Gonzalez ,  Pernille Svalastoga ,  Wubet Worku Takele ,  Claudia Ha-Ting Tam ,  Anne Cathrine B Thuesen ,  Mustafa Tosur ,  Caroline C Wang ,  Jessie J Wong ,  Jennifer M Yamamoto ,  Katherine Young ,  Chloé Amouyal ,  Maxine P Bonham ,  Mingling Chen ,  Feifei Cheng ,  Tinashe Chikowore ,  Sian C Chivers ,  Christoffer Clemmensen ,  Dana Dabelea ,  Adem Y Dawed ,  Aaron J Deutsch ,  Laura T Dickens ,  Linda A DiMeglio ,  Monika Dudenhöffer-Pfeifer ,  Carmella Evans-Molina ,  María Mercè Fernández-Balsells ,  Hugo Fitipaldi ,  Stephanie L Fitzpatrick ,  Stephen E Gitelman ,  Mark O Goodarzi ,  Jessica A Grieger ,  Marta Guasch-Ferré ,  Nahal Habibi ,  Chuiguo Huang ,  Arianna Harris-Kawano ,  Heba M Ismail ,  Benjamin Hoag ,  Randi K Johnson ,  Angus G Jones ,  Robert W Koivula ,  Aaron Leong ,  Gloria K W Leung ,  Ingrid M Libman ,  Kai Liu ,  S Alice Long ,  William L Lowe Jr ,  Robert W Morton ,  Ayesha A Motala ,  Suna Onengut-Gumuscu ,  James S Pankow ,  Maleesa Pathirana ,  Sofia Pazmino ,  Dianna Perez ,  John R Petrie ,  Camille E Powe ,  Alejandra Quinteros ,  Rashmi Jain ,  Mathias Ried-Larsen ,  Zeb Saeed ,  Vanessa Santhakumar ,  Sarah Kanbour ,  Sudipa Sarkar ,  Gabriela S F Monaco ,  Denise M Scholtens ,  Wayne Huey-Herng Sheu ,  Cate Speake ,  Maggie A Stanislawski ,  Nele Steenackers ,  Andrea K Steck ,  Norbert Stefan ,  Julie Støy ,  Rachael Taylor ,  Sok Cin Tye ,  Gebresilasea Gendisha Ukke ,  Marzhan Urazbayeva ,  Bart Van der Schueren ,  Camille Vatier ,  John M Wentworth ,  Wesley Hannah ,  Sara L White ,  Gechang Yu ,  Yingchai Zhang ,  Shao J Zhou ,  Jacques Beltrand ,  Michel Polak ,  Ingvild Aukrust ,  Elisa de Franco ,  Sarah E Flanagan ,  Kristin A Maloney ,  Andrew McGovern ,  Janne Molnes ,  Mariam Nakabuye ,  Pål Rasmus Njølstad ,  Hugo Pomares-Millan ,  Michele Provenzano ,  Cécile Saint-Martin ,  Cuilin Zhang ,  Yeyi Zhu ,  Sungyoung Auh ,  Russell de Souza ,  Andrea J Fawcett ,  Chandra Gruber ,  Eskedar Getie Mekonnen ,  Emily Mixter ,  Diana Sherifali ,  Robert H Eckel ,  John J Nolan ,  Louis H Philipson ,  Rebecca J Brown ,  Liana K Billings ,  Kristen Boyle ,  Tina Costacou ,  John M Dennis ,  Jose C Florez ,  Anna L Gloyn ,  Maria F Gomez ,  Peter A Gottlieb ,  Siri Atma W Greeley ,  Kurt Griffin ,  Andrew T Hattersley ,  Irl B Hirsch ,  Marie-France Hivert ,  Korey K Hood ,  Jami L Josefson ,  Soo Heon Kwak ,  Lori M Laffel ,  Siew S Lim ,  Ruth J F Loos ,  Ronald C W Ma ,  Chantal Mathieu ,  Nestoras Mathioudakis ,  James B Meigs ,  Shivani Misra ,  Viswanathan Mohan ,  Rinki Murphy ,  Richard Oram ,  Katharine R Owen ,  Susan E Ozanne ,  Ewan R Pearson ,  Wei Perng ,  Toni I Pollin ,  Rodica Pop-Busui ,  Richard E Pratley ,  Leanne M Redman ,  Maria J Redondo ,  Rebecca M Reynolds ,  Robert K Semple ,  Jennifer L Sherr ,  Emily K Sims ,  Arianne Sweeting ,  Tiinamaija Tuomi ,  Miriam S Udler ,  Kimberly K Vesco ,  Tina Vilsbøll ,  Stephen S Rich ,  Paul W Franks

Affiliations

• 1 Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK. [email protected].
• 2 Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK. [email protected].
• 3 Department of Endocrinology and Diabetology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
• 4 Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.
• 5 German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
• 6 Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
• 7 Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA.
• 8 Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia.
• 9 Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA.
• 10 Programs in Metabolism and Medical & Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.
• 11 Department of Medicine, Harvard Medical School, Boston, MA, USA.
• 12 Diabetes Unit, Division of Endocrinology, Massachusetts General Hospital, Boston, MA, USA.
• 13 Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
• 14 Department of Pediatrics, Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA.
• 15 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
• 16 Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
• 17 Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
• 18 Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge St 16th Floor, Boston, MA, USA.
• 19 Division of Endocrinology, Diabetes and Metabolism, NorthShore University Health System, Skokie, IL, USA.
• 20 Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
• 21 Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, CO, USA.
• 22 Institute of Molecular and Genomic Medicine, National Health Research Institute, Miaoli County, Taiwan, ROC.
• 23 Division of Endocrinology and Metabolism, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
• 24 Division of Endocrinology and Metabolism, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
• 25 University Hospital of Tübingen, Tübingen, Germany.
• 26 Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, Neuherberg, Germany.
• 27 Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
• 28 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
• PMID: 37798471
• PMCID: PMC10556101
• DOI: 10.1038/s43856-023-00360-3

Background: Heterogeneity in type 2 diabetes presentation and progression suggests that precision medicine interventions could improve clinical outcomes. We undertook a systematic review to determine whether strategies to subclassify type 2 diabetes were associated with high quality evidence, reproducible results and improved outcomes for patients.

Methods: We searched PubMed and Embase for publications that used 'simple subclassification' approaches using simple categorisation of clinical characteristics, or 'complex subclassification' approaches which used machine learning or 'omics approaches in people with established type 2 diabetes. We excluded other diabetes subtypes and those predicting incident type 2 diabetes. We assessed quality, reproducibility and clinical relevance of extracted full-text articles and qualitatively synthesised a summary of subclassification approaches.

Results: Here we show data from 51 studies that demonstrate many simple stratification approaches, but none have been replicated and many are not associated with meaningful clinical outcomes. Complex stratification was reviewed in 62 studies and produced reproducible subtypes of type 2 diabetes that are associated with outcomes. Both approaches require a higher grade of evidence but support the premise that type 2 diabetes can be subclassified into clinically meaningful subtypes.

Conclusion: Critical next steps toward clinical implementation are to test whether subtypes exist in more diverse ancestries and whether tailoring interventions to subtypes will improve outcomes.

Plain language summary

In people with type 2 diabetes there may be differences in the way people present, including for example, their symptoms, body weight or how much insulin they make. We looked at recent publications describing research in this area to see whether it is possible to separate people with type 2 diabetes into different subgroups and, if so, whether these groupings were useful for patients. We found that it is possible to group people with type 2 diabetes into different subgroups and being in one subgroup can be more strongly linked to the likelihood of developing complications over others. This might mean that in the future we can treat people in different subgroups differently in ways that improves their treatment and their health but it requires further study.

© 2023. Springer Nature Limited.

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The Johns Hopkins Guide to Diabetes

Christopher D. Saudek, M.D., Richard R. Rubin, Ph.D., CDE, and Thomas W. Donner, M.D.

A comprehensive and up-to-date guide to the physically, emotionally, and psychologically challenging disease of diabetes. Living with diabetes is a balancing act of monitoring blood glucose, food intake, and medication. It makes sense that individuals who have diabetes do best when they understand their condition and how to control it.

The Johns Hopkins Guide to Diabetes is a comprehensive and easy-to-read guide to this complex condition, answering questions such as: What are the differences between Type 1 and Type 2 diabetes? How are the different forms of this disease treated? Can gestational...

The Johns Hopkins Guide to Diabetes is a comprehensive and easy-to-read guide to this complex condition, answering questions such as: What are the differences between Type 1 and Type 2 diabetes? How are the different forms of this disease treated? Can gestational diabetes become a permanent condition? Can diabetes ever be managed successfully with diet and exercise alone?

The second edition of this valued resource includes up-to-date information on • How diabetes is diagnosed • The two types of diabetes • The role of genetics • Improvements in blood glucose measurement • Good nutrition and regular exercise • Insulin and non-insulin medications • Insulin pumps • The emotional side of diabetes • How families are affected and how they can help • What to do if diabetes affects your work • Complications from head to toe

Written by a team of Johns Hopkins diabetes specialists, this authoritative guide will help people who have diabetes work effectively with their care team to control their diabetes and maintain good health.

Related Books

Tammi L. Shlotzhauer, MD

Chadi Nabhan, MD, MBA, FACP

Joseph Nowinski, PhD foreword by Marvin D. Seppala, MD, former chief medical officer of the Hazelden Betty Ford Foundation

Peter C. Rowe, MD

Steven Q. Wang, MD

[ The Johns Hopkins Guide to Diabetes ] is comprehensive and up-to-date. It is an invaluable reference for diabetics and their families.

This is a comprehensive book, which presents in a reader friendly format relevant clinical data relating to the impact of diabetes for those diagnosed with this condition... This edition is an essential guide for individuals who has diabetes or been recently diagnosed. It could be described as a staple part of diabetes understanding and management.

This comprehensive six-part guidebook aims to help diabetics take control of their condition. Aided by tables, diagrams, and lots of patient anecdotes, the authors identify major types of diabetes, how they are diagnosed and the various treatment options, including diet therapy, insulin, and oral medications. Practical advice on all aspects of care ranges from procedures for monitoring one's blood glucose, eating wisely, and exercising safely to handling the stress of a job interview and working with an HMO.

A browse through any major bookstore will reveal a large number of books written for the layperson on the subject of diabetes mellitus. The Johns Hopkins Guide to Diabetes is one that can be recommended for its clarity and sound scientific information on this disorder.

Presenting critical information about the physical, emotional, and psychosocial effects of diabetes, this valuable work explains the nature of the disease, treatments, diet and exercise, sexuality, pregnancy, and research.

Book Details

Preface Acknowledgments Part I: Understanding Diabetes 1. The Diagnosis of Diabetes: Making It and Hearing It 2. Types of Diabetes Part II: Controlling Diabetes 3. Goals of Treatment and How to Reach Them 4

Preface Acknowledgments Part I: Understanding Diabetes 1. The Diagnosis of Diabetes: Making It and Hearing It 2. Types of Diabetes Part II: Controlling Diabetes 3. Goals of Treatment and How to Reach Them 4. Blood Glucose Monitoring 5. Hypoglycemia 6. Introduction to Nutrition Therapy: Planning and Understanding the Diet 7. Weight Control: Why It Matters and How to Do It 8. Special Considerations in Nutrition Therapy 9. Exercise and Diabetes 10. Treating Type 2 Diabetes with Non-insulin Medications 11. Treating Diabetes with Insulin 12. Types of Insulin 13. Insulin Pumps Part III: Living with Diabetes 14. The Emotional Side of Diabetes 15. Lessons for Families Who Live with Diabetes 16. Dealing with Psychological Problems 17. Interacting with Health Care Professionals 18. Interacting with the Health Care System 19. Employment and Diabetes Part IV: Complications 20. Systemic Symptoms 21. Diabetic Ketoacidosis and Hyperosmolar Coma 22. Hardening of the Arteries 23. Diabetic Eye Disease 24. Diabetic Kidney Disease 25. Diabetic Neuropathy 26. Diabetes and the Foot 27. Diabetes and the Skin Part V: Sexuality, Pregnancy, and Genetics 28. Diabetes and Sexuality 29. Diabetes and Pregnancy 30. The Genetics of Diabetes Part VI: The Future of Care 31. Diabetes Research 32. The Prognosis Index

Christopher D. Saudek, M.D.

Richard r. rubin, ph.d..

Thomas W. Donner, MD

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Together on Diabetes

Focus Area: Diabetes & Obesity Prevention

American Indian youth are affected by obesity and type 2 diabetes at disproportionate rates. These chronic health issues are complex; prevention and treatment requires a comprehensive and holistic approach. Utilizing concepts and program structure from previous evidence-based diabetes prevention programs, four American Indian communities and the Center for American Indian Health developed the Together on Diabetes Program, a family-based, home-visiting diabetes prevention/management program for American Indian youth and their families.

About the Together on Diabetes Program

In 2011, the Center for American Indian Health received a grant from the Bristol Meyers Squibb Foundation to develop and implement Together on Diabetes. Between 2012 and 2015, Family Health Coaches, local paraprofessionals trained in the curriculum and program procedures, delivered Together on Diabetes to 250 youth and their families in four tribal communities.

Together on Diabetes Impacts Multiple System Levels:

Individual Impact : Providing one-on-one, home-based healthy living education and social support to youth with or at-risk of type 2 diabetes. Family Impact : Educating caregivers of young people to create a healthy home environment through lessons delivered in the home. Health Care Impact : Providing youth with transportation to clinic appointments and working with a care team to ensure comprehensive and consistent care. Community Impact : Working with local organizations to provide healthy living opportunities to families. Results

Preliminary results indicate improvements in youth knowledge, quality of life and emotional health, as well as stabilized BMI among participants in the program. Learn more .

This project has been supported by the Bristol-Myers Squibb Foundation. Additional support was provided by the Notah Begay III Foundation.

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Study finds COVID-19 pandemic led to some, but not many, developmental milestone delays in infants and young children

by Johns Hopkins University School of Medicine

Infants and children 5 years old and younger experienced only "modest" delays in developmental milestones due to the COVID-19 pandemic disruptions and restrictions, a study led by Johns Hopkins Children's Center finds.

In a report on the study published in JAMA Pediatrics , investigators evaluated possible links between pandemic-related disruptions to everyday life and changes in developmental milestone screening scores.

The data were from the Comprehensive Health and Decision Information System (CHADIS), a web-based screening platform caregivers use to complete surveys about their children's development. It is used by more than 5,000 pediatric practices in 48 U.S. states.

Using the Ages and Stages Questionnaire-3 (ASQ-3), a caregiver-completed measure of child development routinely collected as part of pediatric care, researchers say they found only small decreases in communication, problem-solving, and personal-social skills and no changes in fine or gross motor skills among children in the study.

"We found, overall, that while there are some changes, the sky is not falling, and that is a really important and reassuring finding," says Sara Johnson, Ph.D., M.P.H., corresponding author of the study, director of the Rales Center for the Integration of Health and Education at Johns Hopkins Children's Center, and Blanket Fort Foundation professor of pediatrics at the Johns Hopkins University School of Medicine.

Numerous studies, the researchers say, found the COVID-19 pandemic and related lockdown restrictions disrupted the lives of many people, including families with young children. Everyday life and daily routines were upended as schools and child care centers closed, many people began working from home, and social contacts diminished. Many experienced increased stress, anxiety, and social isolation due to these changes and activity cancellations.

Research has also shown the pandemic is linked to lower child health-related quality of life , increased mental health concerns , decreased sleep and increased risk of obesity .

However, the impact of the pandemic on developmental milestones among young children in the U.S. remained unclear, in part because studies designed to address them were done outside the United States or in small samples.

In the new study, Children's Center researchers looked at the developmental milestone status of 50,205 children, ages 0 to 5 years, drawn from a sample of more than half a million children whose parents or caregivers completed the ASQ-3. The ASQ-3 assesses children's developmental milestones in five skill domains: communication, gross motor, fine motor, problem-solving, and personal-social.

Researchers compared the children before and during the pandemic from 2018 to 2022 and found ASQ-3 score decreases in the communication (about 3%), problem-solving (about 2%) and personal-social (about 2%) skill domains. They found no changes in fine or gross motor skill domains.

When looking specifically at infants 0–12 months old, similarly modest effects were observed, and there were only decreases in the communication domain (about 3%) and problem-solving domain (about 2%).

"We thought it was possible infants might experience less impact than the older kids, given that many caregivers may have spent more time at home with their very young children ," says Johnson. "But we saw generally the same things in infants as we did for older kids."

Also, given an increase in parent and caregiver worry and stress, researchers investigated whether parents and caregivers reported more worries about their child during the pandemic, regardless of milestone achievement, and found worries about their child only increased slightly during the pandemic, compared to before the pandemic.

While the researchers say the findings are reassuring, they add that the implications for children's long-term development remain unclear.

"It is important for us to continue to keep an eye on kids of all ages in terms of development, so we can understand whether these changes have longer-term implications for children or if new challenges emerge as children age," says Johnson.

Johnson and her team of investigators believe their study findings will aid in planning for future public health crises and also demonstrate the importance of shoring up the clinical infrastructure of overburdened health systems in the U.S., particularly developmental-behavioral pediatricians, who are specially trained to evaluate and treat developmental concerns. These resources will be essential to respond to the developmental needs of children now and in the future.

The investigators cautioned that the study did not factor in some variables that might have changed the findings, such as prenatal substance abuse and other health conditions. In addition, infants born preterm were excluded from the study, which may underestimate developmental impacts for this subgroup.

Researchers also cannot rule out "selection bias" among health care providers participating in CHADIS, and there was no comparison group of children who weren't exposed to COVID-19 pandemic restrictions.

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