PMID- 33544546
OWN - NLM
STAT- MEDLINE
DCOM- 20211011
LR  - 20221207
IS  - 2191-0251 (Electronic)
IS  - 0334-018X (Linking)
VI  - 34
IP  - 2
DP  - 2021 Feb 23
TI  - Distance from the endocrinology clinic and diabetes control in a rural pediatric 
      population.
PG  - 187-193
LID - 10.1515/jpem-2020-0332 [doi]
AB  - 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.
CI  - (c) 2020 Walter de Gruyter GmbH, Berlin/Boston.
FAU - LePage, Ana K
AU  - LePage AK
AD  - Department of Psychology, East Carolina University,GreenvilleNC, USA.
FAU - Wise, J Benjamin
AU  - Wise JB
AD  - Brody School of Medicine at East Carolina University, GreenvilleNC, USA.
FAU - Bell, Jennifer J
AU  - Bell JJ
AD  - Department of Pediatrics, Baylor College of Medicine, HoustonTX, USA.
FAU - Tumin, Dmitry
AU  - Tumin D
AD  - Department of Pediatrics, Brody School of Medicine at East Carolina University, 
      GreenvilleNC, USA.
FAU - Smith, Aimee W
AU  - Smith AW
AD  - Department of Psychology, East Carolina University,GreenvilleNC, USA.
LA  - eng
PT  - Journal Article
DEP - 20201012
PL  - Germany
TA  - J Pediatr Endocrinol Metab
JT  - Journal of pediatric endocrinology & metabolism : JPEM
JID - 9508900
RN  - 0 (Biomarkers)
RN  - 0 (Blood Glucose)
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (hemoglobin A1c protein, human)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Ambulatory Care Facilities/*standards
MH  - Biomarkers/*blood
MH  - Blood Glucose/analysis
MH  - Child
MH  - Child, Preschool
MH  - Diabetes Mellitus, Type 1/epidemiology/*therapy
MH  - Diabetes Mellitus, Type 2/epidemiology/*therapy
MH  - Endocrinology/*standards
MH  - Female
MH  - Follow-Up Studies
MH  - Glycated Hemoglobin/analysis
MH  - Health Services Accessibility/*statistics & numerical data
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Male
MH  - Patient Compliance/*statistics & numerical data
MH  - Prognosis
MH  - Retrospective Studies
MH  - Rural Population
MH  - Young Adult
OTO - NOTNLM
OT  - adherence
OT  - diabetes mellitus
OT  - health services accessibility
OT  - pediatric
OT  - rural population
EDAT- 2021/02/06 06:00
MHDA- 2021/10/12 06:00
CRDT- 2021/02/05 12:17
PHST- 2020/06/04 00:00 [received]
PHST- 2020/08/27 00:00 [accepted]
PHST- 2021/02/05 12:17 [entrez]
PHST- 2021/02/06 06:00 [pubmed]
PHST- 2021/10/12 06:00 [medline]
AID - jpem-2020-0332 [pii]
AID - 10.1515/jpem-2020-0332 [doi]
PST - epublish
SO  - J Pediatr Endocrinol Metab. 2020 Oct 12;34(2):187-193. doi: 
      10.1515/jpem-2020-0332. Print 2021 Feb 23.