title: Consequences of irregular versus continuous medical follow-up in children and adolescents with insulin-dependent diabetes mellitus.
abstract: OBJECTIVE
  To study the social and family characteristics of patients with insulin-dependent diabetes mellitus with irregular versus continuous 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 parents were studied. Aspects of their social and family environment were assessed at study inception and examined in relation to frequency of follow-up early in the course of the illness. Follow-up was dichotomized so that patients with continuous follow-up were compared with patients with irregular follow-up, who were defined as those missing 1 full year of planned medical appointments during the second through fourth 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
  Compared with individuals with continuous follow-up, patients with irregular clinical visits were more likely to be from families of lower socioeconomic class levels, have a parental history of separation and divorce, and were members of families that reported being least openly expressive of positive emotions. Poor glycemic control in year 1 was associated with irregular follow-up in years 2 through 4. Patients with irregular follow-up continued to have worse glycemic control in years 2 through 4 than patients with continuous follow-up. However, in years 7 and 10 their glycemic control no longer differed from patients with continuous follow-up. More episodes of diabetic ketoacidosis occurred in the irregular follow-up group. Finally, retinopathy occurred more frequently among those in the irregular follow-up group.
  
  
  CONCLUSIONS
  Early irregular clinical follow-up should be considered a risk factor for complications of insulin-dependent diabetes mellitus.
authors.affiliation: Department of Psychiatry, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Jacobson
authors.forename: S T
authors.initials: ST
authors.lastname: Hauser
authors.forename: J
authors.initials: J
authors.lastname: Willett
authors.forename: J I
authors.initials: JI
authors.lastname: Wolfsdorf
authors.forename: L
authors.initials: L
authors.lastname: Herman
mesh_terms: D000293:Adolescent; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis* / Q000188:drug therapy; D016883:Diabetic Ketoacidosis / Q000175:diagnosis / Q000517:prevention & control; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000517:prevention & control; D005190:Family / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis / Q000517:prevention & control; D008137:Longitudinal Studies; D008297:Male; D012923:Social Class