Less than 20% of pediatric patients with type 1 diabetes (T1D) in the U.S. achieve target A1c values, with rising A1c trends between age 6 to 17 years. The International Society of Pediatric and Adolescent Diabetes recommends outpatient clinic visits at least every 3 months, while the American Diabetes Association recommends every 3-6 months. The T1D Exchange Quality Improvement Collaborative aims to improve the quality of T1D care in the U.S. by identifying variations in care and sharing best practices.

Six pediatric diabetes clinics in the Collaborative reported the mean number of days between outpatient diabetes clinic visits for patients with T1D aged 0-6, 7-12, 13-17, and 17-26 years for each month from 11/2017-10/2018. Patients with new onset T1D were excluded, as were those with visit interval >13 months.

Analysis included 31,358 patients. Age group and clinic site (both p<.001) were associated with interval between clinic visits (Figure 1), but month was not (p=.87). Mean number of days was >90 for each age group.

The majority of patients attended clinic less often than required to meet 4 encounters per year. Older age was associated with longer interval between visits. Improving outcomes will require a combination of increasing the perceived value of clinic attendance, increasing access to outpatient encounters, and innovative methods of care delivery outside regular clinic attendance.


G.T. Alonso: None. S. Thomas: None. C. Garey: None. D.A. Buckingham: None. A.B. Cabrera: None. M.A. Clements: Advisory Panel; Self; Glooko, Inc. Consultant; Self; Eli Lilly and Company. Speaker's Bureau; Self; Medtronic. S. Corathers: None. D.J. DeSalvo: Consultant; Self; Dexcom, Inc., Insulet Corporation. A. Garrity: None. J.M. Lee: Consultant; Self; Taiho Oncology, Inc. R. McDonough: None. F. Mostajabi: None. C. Yee: None. M.K. Kamboj: None.


The Leona M. and Harry B. Helmsley Charitable Trust

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.