What happens to defaulters from a diabetic clinic?

Abstract

The annual rate at which patients defaulted from follow up at the Wolverhampton diabetic clinic between 1971 and 1981 was 4-1% overall and 3 5% in white patients. In 1982 a study was started to discover what happened to white patients, born after 1919, who defaulted from the hospital clinic. There were 162 defaulters, of whom 19 had died. Of the remaining 143 patients, 19 were attending another hospital diabetic clinic, 22 had moved out of the area, and 28 refused to participate in the study. Seventy four agreed to participate: 39 were treated with diet, 15 with oral hypoglycaemic agents, and 20 with insulin. They were matched for sex, age, treatment, and duration of diabetes with patients attending the clinic.Non-insulin dependent defaulters were significantly more overweight at diagnosis (40% v 25%; p<0 05) and remained more obese. They developed significantly higher diastolic blood pressure (94 v 86 mm Hg; p<002) and higher haemoglobin A, (HbA,) concentrations (11.7% v 8-4%; p<001). They had significantly more neuropathy at reassessment (15 v 6 out of 54; p<005) and a greater incidence of new retinopathy (p<002), which correlated with their higher diastolic blood pressures (p<0-01) and HbA, concentration (p<0.02). In defaulters who were treated with insulin only the prevalence of neuropathy was significantly different from that in controls (p<005).Defaulters received minimal medical supervision and suffered greater morbidity than regular attenders at the clinic. Introduction Diabetic care in this district comprises a hospital run by consultants and 23 general practice diabetic clinics run independently (mini clinics). Patients who attended either clinic between 1971 and 1981 had a punchcard giving basic information and treatment, as previously described.' Information on attenders is continually updated.In a survey of punchcards carried out in 1982 1117 people attended the hospital clinic and 1061 the mini clinic practices. The overall annual rate of defaulting from the hospital clinic was 4 1% with annual rates of Il% for patients receiving diet alone, 6% for those treated with oral hypoglycaemics, and 4% and 1% for those treated with insulin once or twice a day, respectively. Defaulting from mini clinics is much less of a problem and is not reviewed here.

Prevalence and characteristics of diabetic patients with no ongoing care in South Auckland.

“…The data conflict with those from specialist clinics and studies of type 1 diabetes care, which have suggested that nonattenders are more likely to suffer from complications (8,9) and are more likely to smoke (9). The data do confirm the findings of Graber et al (9), who showed that nonattenders are less likely to have been prescribed medication.…”

Personal features and dropout from diabetic care

“…The reasons for dropout from a diabetic care can be generally summarized into the following three categories: 1) patient-oriented problem (2,(11)(12)(13)(14)(15)(16)(17), 2) health-care provideroriented problem (11,18,19), and 3) physician-patient relationship (5,20). For the patient-oriented problem, gender, age, ethnicity, educational level, economical status, tobacco use, obesity, the duration of disorder, glycemic control, and psychological problems among others can be considered.…”

Microvascular and acute complications in IDDM patients: the EURODIAB IDDM Complications Study

“…Clinic-based estimates of the regional prevalence of complications will be biased if clinic-attenders have more or fewer complications than the population of IDDM patients from which the attenders are drawn. While some patients may be referred to clinics because of advanced complications, others' motivation to attend may be associated with better control and fewer complications than in non-attenders [10]. Individual clinics may therefore over-or underestimate the regional prevalence of complications, depending on the balance between these opposing biases.…”