Association between diabetes control and visits to a multidisciplinary pediatric diabetes clinic

To determine if there is a relationship between diabetes outcome as measured by HbA1C and the number of multidisciplinary clinic visits per year in children and youth with diabetes.

The number of clinic visits per year, the mean HbA1C (by DCA 2000, Miles, Tarrytown, NY), type of insurance, parental marital status, parental age, maximal parental grade level achieved, family income, self-identified race, and scores on adherence and knowledge tests were compared for 1995 in 360 patients with a mean age of 11.6 +/- 4.8 years (1-2 visits, 85 patients; 3-4 visits, 275 patients), for 1996 in 412 patients with a mean age of 11.6 +/- 4.7 years (1-2 visits, 115 patients; 3-4 visits, 297 patients), and for 1997 in 442 patients with a mean age of 11.8 +/- 4.9 years (1-2 visits, 126 patients; 3-4 visits, 332 patients).

There was a significant difference in the mean HbA1C levels between subjects with 1 to 2 visits versus 3 to 4 visits during the 3 years of this study. In 1995, the mean HbA1C was 9.0 +/- 2.0% for subjects with 1 to 2 visits and 8.3 +/- 1.6% for subjects with 3 to 4 visits. In 1996, the mean HbA1C was 9.3 +/- 2.0% for subjects with 1 to 2 visits and 8.4 +/- 1.6% in those with 3 to 4 visits, whereas in 1997, the mean HbA1C was 9.1 +/- 1.9% with 1 to 2 visits and 8.3 +/- 1.5% with 3 to 4 visits. There was a significant difference in the number of visits by the age of the subject. The mean age of patients with 1 to 2 visits was 13.6 +/- 4.5 years; it was 10.8 +/- 4.6 years with 3 to 4 visits. However, for age groups <13 years versus >/=13 years, there was still a difference between HbA1C levels for subjects with 1 to 2 visits compared with 3 to 4 visits (8.9 +/- 1.7% versus 8.1 +/- 1.3%, respectively). The only patient/family characteristic that had an association with number of visits was the marital status of the parents. Children from single-parent households had fewer visits. There was no association between health insurance status and number of visits and there was no difference between the number of visits and the mean scores on tests of adherence or knowledge. Multivariate analysis showed that the number of visits was a significant predictor of HbA1C even after controlling for age, duration of diabetes, and scores on adherence and knowledge tests.

The finding that subjects with more frequent visits to a multidisciplinary diabetes clinic had lower HbA1C levels during the 3 years of this study suggests that strategies should be developed to promote adherence with quarterly visits, particularly targeted to children from single-parent households and to teens.