Dropout and relapse during diabetes care.
OBJECTIVE
To determine factors associated with dropout and relapse during chronic diabetes care.


METHODS
Private practice outpatient treatment-education program for adult diabetes was surveyed. Retrospective analysis was done, involving 422 patients for up to 3 yr.


RESULTS
Of the patients in the study, 12% dropped out after the initial visit, and 33% of the residual cohort dropped out during each subsequent 6-mo period. Factors associated with dropout included distance from home to clinic > 100 miles, lack of insulin treatment, and cigarette smoking. In patients who remained in follow-up, a significant decrease in HbA1C occurred during the first 6 mo, but 40% of the patients relapsed between 6 and 12 mo. Frequency of relapse declined as time passed. Relapse was more frequent in women.


CONCLUSIONS
Dropout from treatment and relapse after temporary improvement account for a substantial amount of uncontrolled diabetes, and overcoming the obstacles of dropout and relapse has potential for significant improvement in diabetes care.
Graber
A L
AL
Department of Internal Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
Davidson
P
P
Brown
A W
AW
McRae
J R
JR
Woolridge
K
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000534:rehabilitation*; D003922:Diabetes Mellitus, Type 1 / Q000534:rehabilitation; D003924:Diabetes Mellitus, Type 2 / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts; D010353:Patient Education as Topic; D011331:Private Practice; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors
D006442:Glycated Hemoglobin; D007328:Insulin