CONSEQUENCES OF IRREGULAR VERSUS CONTINUOUS MEDICAL FOLLOW-UP IN CHILDREN AND ADOLESCENTS WITH INSULIN-DEPENDENT DIABETES-MELLITUS

Objectives: To study the social and family characteristics of patients with insulin-dependent diabetes mellitus with irregular versus contin uous clinical follow-up and to study the medical outcomes of patients with these follow-up patterns. Methods: An onset cohort of 61 children and adolescents with insulin-dependent diabetes mellitus and their pa rents were studied. Aspects of their social and family environment wer e assessed at study inception and examined in relation to frequency of follow-up early in the course of the illness. Follow-up was dichotomi zed so that patients with continuous follow-up were compared with pati ents with irregular follow-up, who were defined as those missing 1 ful l year of planned medical appointments during the second through fourt h years after diagnosis. Patients with irregular and continuous follow -up were compared in terms of acute metabolic complications, glycemic control, and retinopathy status during a 10-year period. Results: Comp ared with individuals with continuous follow-up, patients with irregul ar clinical visits were more likely to be from families of lower socio economic class levels, have a parental history of separation and divor ce, and were members of families that reported being least openly expr essive of positive emotions. Poor glycemic control in year 1 was assoc iated with irregular follow-up in years 2 through 4. Patients with irr egular follow-up continued to have worse glycemic control in years 2 t hrough ii than patients with continuous follow-up. However, in years 7 and 10 their glycemic control no longer differed from patients with c ontinuous follow-up. More episodes of diabetic ketoacidosis occurred i n the irregular follow-up group. Finally, retinopathy occurred more fr equently among those in the irregular follow-up group. Conclusion: Ear ly irregular clinical follow-up should be considered a risk factor for complications of insulin-dependent diabetes mellitus.