Distance from the endocrinology clinic and diabetes control in a rural pediatric population
-
Ana K. LePage
,
J. Benjamin Wise
Abstract
Objective
We analyzed the impact of geographic distance from the clinic on adherence to recommended clinic visits and diabetes control among patients with type 1 diabetes (T1D) seen in a pediatric endocrinology clinic serving a rural region in eastern North Carolina.
Methods
We retrospectively included patients with T1D age ≤20 years seen in our clinic during 2017. Outcomes were tracked until June 2018. Distance from the clinic was determined according to the zone improvement plan (ZIP) code of patient address. Visit adherence was defined based on the number of attended visits during the study period, aiming for 1 every 3 months. Glycated hemoglobin (HbA1c) was measured at the first and last visits during the review period
Results
The analysis included 368 patients, of whom 218 (59%) completed at least 1 visit every 3 months. The median HbA1c was 9.1 (interquartile range [IQR]: 8.0, 10.3) at the initial visit, and 9.3 (IQR: 8.0, 11.1) at the final visit. Median distance from the clinic was 56 km (IQR: 35, 86). On multivariable logistic regression, greater distance from the clinic was associated with lower odds of visit adherence (odds ratio per 10 km: 0.93; 95% confidence interval: 0.87, 0.99; p=0.030). Neither distance to the clinic nor clinic visit adherence were associated with HbA1c.
Conclusions
Patients living further away from the clinic were less likely to adhere to the recommended visit schedule, but distance was not correlated with HbA1c levels. Further work is needed to assist families living far from the clinic with adhering to recommended visits.
Acknowledgments
The authors thank Lindsay Cortright, MA, Kaitlin Hamilton, PA-C, Callie Pawlowski, BS, and Bennett Wall, MBA for assistance with data acquisition for this project.
Research Funding: No funding was received for this research.
Author contributions: AKL, JBW, JJB, DT, and AWS contributed to study conception and design. AKL, JBW, and JJB contributed to data collection. DT contributed to data analysis. AKL, JBW, JJB, and AWS contributed to interpretation of the data. AKL, JBW, and DT contributed to drafting the manuscript. JJB and AWS contributed to critical revision of the manuscript. All authors have approved the final version of the manuscript and agree to be held accountable for its content.
Conflict of interest: All authors have no conflicts of interest to disclose.
Ethical approval: The study was approved by the Institutional Review Board at East Carolina University with a waiver of individual consent.
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© 2020 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Review Article
- The current review of adolescent obesity: the role of genetic factors
- Original Articles
- Trends in abdominal obesity among Chinese children and adolescents, 1993–2015
- Association of childhood obesity with retinal microvasculature and corneal endothelial cell morphology
- Communication frequency between visits is associated with improved glycemic control in pediatric diabetes
- Increased length of stay and hospital charges in adolescents with type 1 diabetes and psychiatric illness
- Distance from the endocrinology clinic and diabetes control in a rural pediatric population
- Care of children with type 1 diabetes mellitus in school – An interventional study
- Treatment and long-term follow-up of patients diagnosed with type 1 diabetes mellitus before age 5
- Diabetes distress in Indian children with type 1 diabetes mellitus and their mothers
- Impact of lockdown for COVID-19 pandemic in Indian children and youth with type 1 diabetes from different socio-economic classes
- First report on the nationwide prevalence of paediatric type 1 diabetes in Serbia and temporal trends of diabetes ketoacidosis at diagnosis—a multicentre study
- Factors affecting thyroid volume in adolescent students attending a rural middle school in East Hangzhou, China
- Impact of maternal thyroid disease on neonatal thyroid status
- Impact of growth hormone treatment on scoliosis development and progression: analysis of 1128 patients with idiopathic short stature
- Short Communication
- Are we ignoring coexisting rhabdomyolysis as an important aggravating factor for acute kidney injury among childhood diabetic ketoacidosis?
- Case Reports
- Microdeletion in the IGF-1 receptor gene of a patient with short stature and obesity: a case report
- SLC25A19 deficiency and bilateral striatal necrosis with polyneuropathy: a new case and review of the literature
- Familial neonatal nonautoimmune hyperthyroidism due to a gain-of-function (D619G) thyrotropin-receptor mutation
- Transient neonatal diabetes due to a disease causing novel variant in the ATP-binding cassette subfamily C member 8 (ABCC8) gene unmasks maturity-onset diabetes of the young (MODY) diabetes cases within a family
Articles in the same Issue
- Frontmatter
- Review Article
- The current review of adolescent obesity: the role of genetic factors
- Original Articles
- Trends in abdominal obesity among Chinese children and adolescents, 1993–2015
- Association of childhood obesity with retinal microvasculature and corneal endothelial cell morphology
- Communication frequency between visits is associated with improved glycemic control in pediatric diabetes
- Increased length of stay and hospital charges in adolescents with type 1 diabetes and psychiatric illness
- Distance from the endocrinology clinic and diabetes control in a rural pediatric population
- Care of children with type 1 diabetes mellitus in school – An interventional study
- Treatment and long-term follow-up of patients diagnosed with type 1 diabetes mellitus before age 5
- Diabetes distress in Indian children with type 1 diabetes mellitus and their mothers
- Impact of lockdown for COVID-19 pandemic in Indian children and youth with type 1 diabetes from different socio-economic classes
- First report on the nationwide prevalence of paediatric type 1 diabetes in Serbia and temporal trends of diabetes ketoacidosis at diagnosis—a multicentre study
- Factors affecting thyroid volume in adolescent students attending a rural middle school in East Hangzhou, China
- Impact of maternal thyroid disease on neonatal thyroid status
- Impact of growth hormone treatment on scoliosis development and progression: analysis of 1128 patients with idiopathic short stature
- Short Communication
- Are we ignoring coexisting rhabdomyolysis as an important aggravating factor for acute kidney injury among childhood diabetic ketoacidosis?
- Case Reports
- Microdeletion in the IGF-1 receptor gene of a patient with short stature and obesity: a case report
- SLC25A19 deficiency and bilateral striatal necrosis with polyneuropathy: a new case and review of the literature
- Familial neonatal nonautoimmune hyperthyroidism due to a gain-of-function (D619G) thyrotropin-receptor mutation
- Transient neonatal diabetes due to a disease causing novel variant in the ATP-binding cassette subfamily C member 8 (ABCC8) gene unmasks maturity-onset diabetes of the young (MODY) diabetes cases within a family
