Abstract
Objective
To investigate the personal features associated with dropout from regular outpatient care among persons with type 2 diabetes mellitus (DM).
Methods
A total of 160 DM patients were enrolled in the study. As a retrospective analysis, outpatient’s clinical characteristics, lifestyle, or social features were gathered from their medical records or interview sheets. All the subjects were divided into two groups by adherence to diabetic care, namely, ‘dropout case’ (DC), or ‘ongoing case’ (OC), and were subjected to comparative analysis. We called the patients who did not receive outpatient treatment from the clinic on a regular basis, including treatment from other clinics or dropout of diabetic care, as DC. In contrast, patients who regularly visited the clinic were defined as OC. An unconditional multiple logistic regression analysis was performed to analyze the association of a dherence to diabetic care with several personal features.
Results
Sixty-eight of 160 subjects (42.5%) were recognized as DC. The remaining 92 subjects (57.5%) were considered as OC. Young age (p=0.045), low plasma glucose (p=0.005) and hemoglobin A1c (HbA1c) levels (p=0.005), nonmedication (p<0.001) and no past history of DM (p=0.007) at the initial visit were the features related to dropout by crude analysis. Even after adjustment for age and gender by multivariate analysis, there remained significant inverse associations of dropout with HbA1c level, medical treatment (oral agents or insulin) and previous DM history. Neither occupation, distance from residence to clinic, smoking habit nor drinking habit was associated with dropout. Dropout mostly occurred after the initial or second visit.
Conclusions
A mild condition of DM may be related to dropout from regular outpatient care. It may be necessary to clearly show the objectives and importance of regular visit to an outpatient clinic for diabetic care, particularly for screened mild DM cases in public health activities.
Key words: type 2 diabetes mellitus, dropout, social features, outpatient, care
References
- (1).Naithan DM. Initial management of glycemia in type 2 diabetes mellitus. N Engl J Med. 2002;347:1342–1359. [DOI] [PubMed]
- (2).Griffin SJ. Lost to follow-up: the Problem of Defaulters from Diabetes Clinics. Diabetic Medicine. 1985;15(suppl.3):S14-S24. [DOI] [PubMed]
- (3).Anderson LA. Health-care communication and selected psychosocial correlates of adherence in diabetes management. Diabetes Care. 1990;13:66–76.
- (4).Cramer JA. A systematic review of adherence with medication for diabetes. Diabetes Care. 2004;27:1218–1224. [DOI] [PubMed]
- (5).Golin CE, DiMatteo MR, Gelberg L. The role of patient participation in the doctor visit. Implications for adherence to diabetes care. Diabetes Care. 1996;19:1153–1164. [DOI] [PubMed]
- (6).Hitchcock PN, Larme AC, Meyer J, Marsh G, Correa A, Pugh JA. Patient choice in diabetes education curriculum. Diabetes Care. 1998;21:896–901. [DOI] [PubMed]
- (7).Polonsky WH, Jacobson M, Anderson BJ, Aponte JE, Loerer PA Schwartz C, Welch G. Assessment of diabetes-related distress. Diabetes Care. 1995;18:754–760. [DOI] [PubMed]
- (8).Ismali K, Winkley K, Rabe-Hesketch S. Systematic review and meta-analysis of randomised controlled trials of psychological interventions to improve glycaemic control in patients with type 2 diabetes. Lancet. 2004;363:1589–1597. [DOI] [PubMed]
- (9).Grigsby AB, Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. Prevalence of anxiety in adults with diabetes, A systematic review. J Psychosom Res. 2002;53:1053–1060. [DOI] [PubMed]
- (10).Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: A meta-analysis. Diabetes Care. 2001;24:1069–1078. [DOI] [PubMed]
- (11).Graver AL, Davidson P, Brown AW, McRae JR, Woolridge K. Dropout and relapse during diabetes care. Diabetes Care. 1992;15:1477–1483. [DOI] [PubMed]
- (12).Hammersley MS, Holland MR, Walford S, Thorn PA. What happens to defaulters from a diabetic clinic? Br Med J. 1985;291:1330–1332 [DOI] [PMC free article] [PubMed]
- (13).Archibald LK, Gill GV. Diabetic clinic defaulters—who are they and why do they default? Practical Diabetes. 1992;9:13–14. [DOI]
- (14).Belville R, Florman D, Nechemias C. Health services research in action: explaining a decrease in patient visits at a diabetes clinic. Mt Sinai J Med. 1985;52:702–707. [PubMed]
- (15).Cook CB, Lyles RH, El-Kebbi I, Ziemer DC, Gallina DL, Dunbar VG, et al. The potentially poor response to outpatient diabetes care in urban African-Americans. Diabetes Care. 2001;24:209–215. [DOI] [PubMed]
- (16).Simmons D, Fleming C. Prevalence and characteristics of diabetic patients with no ongoing care in South Auckland. Diabetes Care. 2000;23:1791–1793. [DOI] [PubMed]
- (17).Kawahara R, Amemiya T, Yoshino M, Miyamae M, Sasamoto K, Omori Y. Dropout of young non-insulindependent diabetics from diabetic care. Diabetes Res Clin Pract 1994;24:181–185. [DOI] [PubMed]
- (18).Scobie IN, Rafferty AB, Franks PC, Sonksen PH. Why patients were lost from Follow-up at an urban diabetic clinic. Br Med J. 1994;1983:189–190. [DOI] [PMC free article] [PubMed]
- (19).Hardy HJ, O’Brien SV, Furlong NJ. Information given to patients before appointments and its effect on nonattendance rate. Br Med J. 2001;323:1298–1300. [DOI] [PMC free article] [PubMed]
- (20).Dulmen MD, Verhaak PFM, Bilo HJG. Shifts in doctorpatient communication during a series of outpatient consultations in non-insulin-dependent diabetes mellitus. Patient Educ Couns. 1997;30:227–237. [DOI] [PubMed]
- (21).The expert committee on the diagnosis and classification of diabetes mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 1997;20:1183–1197. [DOI] [PubMed]
- (22).Hatakeyama I, Maruko T, Ida Y, Tsuruoka A, Maehata E. Fundamental and clinical evaluation for glycosylayed hemoglobin measurement kit “Determiner HbAlc” using latex agglutination immunoassay. Medicine and Pharmacy 1999;41:1181–1186.
- (23).Itoh C. Countermeasure for diabetes care based on “Healthy Japan 21”. Diabetes Journal. 2005;33:69–72.
- (24).Riddle M. Combining sulfonylureas and other oral agents. Am J Med. 2000;108:15s-22s. [DOI] [PubMed]
- (25).American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care. 2000;23 supl.1:s32-s42. [PubMed]
- (26).Bergenstal RM, Kendall DM, Fanz MJ, Rubenstein AH. Management of type 2 diabetes: a systematic approach to meeting the standards of care II: oral agents, insulin, and managements of complications. In: DeGroot LJ, Jameson JL editors. Endocrinology, 4th ed. Vol. 1. Philadelphia: W.B. Saunders Company; 2001. P. 821–835.
- (27).Balkrishnan R, Rajagoparan R, Camacho FT, Huston SA, Murray FT, Anderson RT. Predictors of medication adherence and associated health care costs in an older population with type 2 diabetes melitus: a longitudinal cohort study. Clin Ther. 2003;25:2958–2971. [DOI] [PubMed]