Consequences of irregular versus continuous medical follow-up in children and adolescents with insulin-dependent diabetes mellitus☆,☆☆,★
Section snippets
Subjects
Table I presents the demographic and medical characteristics of the patients enrolled in the study. The patients were selected within 1 year of onset of IDDM. All patients between the ages of 9 and 16 years who were seen at the Joslin Diabetes Center’s Pediatric Unit were invited to participate in the study. No patients were excluded on the basis of psychologic characteristics. Of those recruited, 76% (N = 61) agreed to participate. All subjects except one were white children; the remaining
Clinic Attendance and Year 1 Demographic, Family, and Medical Characteristics
Twelve (20%) of the 61 patients did not have appointments in at least 1 year during years 2 through 4. We compared these patients with irregular follow-up with the 49 patients with continuous follow-up (Table II) . Two demographic dimensions distinguished the groups: socioeconomic class and parent marital history. Patients from the two higher SES groups were least likely to have irregular follow-up, whereas those from the three lower SES groups were most likely to have an irregular pattern of
Discussion
Retinopathy 10 years after diagnosis of IDDM was more commonly found among those with early irregular follow-up. The logistic regression analyses are consistent with the interpretation that medical care exerts its influence on complications development through its relation with glycemic control. The hopeful finding of improved glycemic control by years 7 and 10 among those with early irregular follow-up may lead to a decrease in relative risk later in the course of diabetes. It is not clear to
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Defining a Childhood Type 1 Diabetes Cohort, Clinical Practice Measures, and Outcomes Within Administrative Data in British Columbia
2024, Canadian Journal of DiabetesDiabetes education in pediatrics: How to survive diabetes
2021, Disease-a-MonthCitation Excerpt :Studies in other countries have also observed decreased outpatient utilization and clinic attendance after transition to adult care.242,243 Both delay in transition and decreasing follow-up visits once transitioned contribute to increased risk of short-term and long-term adverse outcomes of poor glycemic control, as well as increased rates of hospitalizations and emergency room visits.238,244,245 Although most providers, pediatric or adult, agree that the transition process is necessary, very few practices have programs in place for a more effective and well-defined approach to prepare older adolescents as well as emerging adults.
Association of Self-Efficacy, Transition Readiness and Diabetes Distress With Glycemic Control in Adolescents With Type 1 Diabetes Preparing to Transition to Adult Care
2021, Canadian Journal of DiabetesCitation Excerpt :Lower income families may be limited in purchasing blood glucose test strips or continuous glucose monitoring systems, which are not universally covered, potentially leading to a reduced frequency of glucose monitoring and an increased risk of suboptimal glycemic control (4). In addition, transportation costs or restrictions in taking time off of work may limit lower income families’ abilities to attend diabetes care visits regularly, resulting in missed opportunities for education, guidance and support (39,40). We found that better transition readiness was associated with better glycemic control, suggesting a potential protective effect of transition readiness.
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2020, Journal of PediatricsCitation Excerpt :Nevertheless, DKA after the diagnosis of diabetes is preventable. Poor adherence to diabetes care has been shown to be associated with higher rates of DKA after the diagnosis of diabetes.41 In BC, we previously reported a 78% reduction in the odds of adhering to national and international diabetes guidelines at 4 years post-diagnosis of type 1 diabetes in youth.42-45
Hyperglycemia in Young Adults With Types 1 and 2 Diabetes Seen in the Emergency Department: A Health Records Review
2018, Canadian Journal of DiabetesCitation Excerpt :These studies have demonstrated that structured programs can potentially result in outcomes for emerging adults that are better than unstructured transfers of care, resulting in fewer losses to follow up, lower glycated hemoglobin levels, fewer admissions for diabetic ketoacidosis and fewer long-term complications (25–29). However, despite the effectiveness of these programs, most authors acknowledge that there are significant gaps in follow up for these transitional adults, resulting in a subsequent increase in hospitalization and use of acute care health services for diabetic and hyperglycemic emergencies (30–32). One recent study examining predictors of type 1 diabetes mellitus outcomes in young adults after transition from pediatric care found that a history of pediatric hospitalization for hyperglycemia and high school versus university education were predictors of subsequent hospitalization for hyperglycemia (33).
Health outcomes for youth with type 1 diabetes at 18 months and 30 months post transition from pediatric to adult care
2018, Diabetes Research and Clinical Practice
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Supported by National Institutes of Health grant No. DK27845, and National Institute of Mental Health Research Scientist Award 5K-02-MH70178 (S.T.H.).
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Reprint requests: Alan M. Jacobson, MD, Joslin Diabetes Center, One Joslin Place, Boston, MA 02215.
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0022-3476/97/$5.00 + 0 9/21/80749