Importance of Outpatient Supervision in the Prognosis of Juvenile Diabetes Mellitus: A Cost/Benefit Analysis

The object of this study was to investigate whether outpatient follow-up visits to a subspecialized clinic have a favorable effect upon length of life of juvenile diabetic patients, and to evaluate whether the cost of suchoutpatient supervision is in reasonable proportion to the benefit obtained. The study comprises 180 insulin-dependent diabetic patients in whom a diagnosis had been made before 1933, and before they were 31 years of age. The patients had been admitted to the Steno Memorial Hospital before their fifteenth year of diabetes. Sixteen patients could not be traced after forty years of diabetes, while the others were followed until death or until their fortieth year with diabetes. Seventy-seven patients never attended follow-up in the outpatient clinic, while the others attended one to 145 times in thecourse of their first twenty years of diabetes. From the results it is apparent that the duration of diabetes correlated with increased frequency of outpatient follow-up. With 4.4 annual outpatient follow-up visits, the duration of diabetes was prolonged by 11.9 years. The cost of this was estimated at $10,468 per patient over forty years. The benefit per patient over the entire forty years was $100,656. These findings suggest that outpatient supervision of diabetes in a subspecialized clinic is beneficial for patients and involves relatively little cost.