Association of Patient and Geographic Variables in Pediatric Patients With Prediabetes Becoming Lost to Follow-up

TL;DR

This study finds that offering telemedicine visits increases follow-up rates in pediatric prediabetes patients.

Contribution

The study identifies telemedicine as a novel factor associated with reduced loss to follow-up in pediatric prediabetes care.

Findings

24.6% of pediatric prediabetes patients were lost to follow-up.

Telemedicine visits were most strongly associated with returning to clinic.

Insurance type and pre-COVID referrals also influenced follow-up likelihood.

Abstract

Prediabetes (PD) is becoming more common, and management is complicated by high rates of loss to follow-up. We evaluated variables associated with lost to follow-up status for pediatric patients with PD referred to endocrinology for evaluation and management.

We evaluated new patients referred to Children's of Alabama Endocrinology for PD from March 2017 through March 2021. Variables included patient medical and demographics as well as county-level metrics. Comparisons of patients who returned to clinic and those who were lost to follow-up were assessed by chi-square for categorical variables and Student’s t-test/Wilcoxon rank sum test for continuous normal/skewed variables, respectively. Univariate logistic regression modeling identified risk factors for coming lost to follow-up and odds ratios with 95% confidence intervals were reported with a 2-sided P-value for significance of <.05.

A total of 524 patients were included in the analysis. Almost one-fourth of patients were lost to follow-up (24.6%). The odds of returning to clinic were higher in patients with the Children's Health Insurance Plan, who were prescribed endocrine medications, who had a concurrent diagnosis of cholesterol disorder, who had referral to the endocrine clinic before COVID-19, and who were offered a telehealth visit. No other assessed variable was significantly associated with the likelihood of returning to clinic.

Independent of obesity severity, age, sex, race, county-level health, and economic variables, the factor most strongly associated with returning to clinic was having a telemedicine visit scheduled. Our data suggest that offering telemedicine visits may reduce lost to follow-up rates in this patient population.

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