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Missed Medical Appointments and Disease Control in Children With Type 1 Diabetes

Kristine Fortin, Elizabeth Pries, Soyang Kwon

    Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Associates & Practitioners
    |November 13, 2015
    PubMed

    Insights

    Missed medical appointments in children with type 1 diabetes are linked to poor disease control. Children missing two or more appointments were more likely to experience diabetic ketoacidosis and have high hemoglobin A1c levels.

    Area of Science:

    • Pediatrics
    • Endocrinology
    • Public Health

    Background:

    • Identifying children with type 1 diabetes at risk for adverse outcomes is crucial.
    • Missed medical appointments are a potential, yet understudied, indicator of poor disease management in pediatric type 1 diabetes.

    Purpose of the Study:

    • To determine the frequency of missed appointments in children with type 1 diabetes.
    • To evaluate the association between missed appointments and indicators of poor glycemic control and adverse events.

    Main Methods:

    • Retrospective review of medical records for 1,002 children (0-17 years) with type 1 diabetes.
    • Analysis of appointment attendance over a 43-month period.
    • Comparison of disease control metrics (hemoglobin A1c, diabetic ketoacidosis episodes) between groups with different missed appointment frequencies.

    Main Results:

    • 15% of patients missed two or more appointments.
    • Patients missing two or more appointments were three times more likely to have diabetic ketoacidosis.
    • These patients also had three times higher odds of hemoglobin A1c levels ≥8.5% and were more likely to belong to minority groups and have public insurance.

    Conclusions:

    • Missed medical appointments in pediatric type 1 diabetes correlate significantly with poorer disease control and increased risk of complications.
    • Missed appointments may serve as a valuable early warning sign for treatment non-adherence.
    • Targeted interventions are needed for children with type 1 diabetes who frequently miss appointments to improve health outcomes.

    Keywords:
    Adherencemedical caremedical neglectoutcomestype 1 diabetes mellitus

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