Background: Despite well-established national complication screening programmes for patients with diabetes, complication rates in young adults with type 1 diabetes (T1D) remain high and uptake of screening unclear. It is important to determine risk factors that restrain newly diagnosed patients from attending the health care services.
Methods: Our incident cohort included all 1832 patients who were diagnosed with T1D younger than 16 years of age between 1990 and 2009 at the Children's Hospital at Westmead, Sydney, NSW. Median age at diagnosis was 8.8 years [5.5-11.6] and 51% were female. Data was analysed from all their documented visits at our clinic between 1st January 1990 and 22nd February 2017 including personal data, clinical variables, blood tests. DCAS attenders (67%) were compared to non-DCAS attenders (34%) for: BMI, HbA1c and socioeconomic disadvantage (SES) which was based on postal codes of Australian Bureau of Statistics.
Results: Comparing non-DCAS attenders with DCAS attenders, diabetes clinic attendance in the first 2 years was 1.7 vs. 2.5 times per year (p<0.001), with a significant difference in their median HbA1c (7.9 vs. 8.0%, p=0.03) over this time, but no difference in BMI at 2-years. The difference in median lifetime HbA1c was even more significant (8.1 vs. 8.3%, p=<0.001). DCAS attenders continued in the Diabetes Service for a mean of 9.1 years whereas the non-DCAS attenders were followed for 3.8 years (p<0.001). 40% of the non-DCAS group were socio-economical disadvantaged compared to only 23% of the DCAS group (p<0.001). In multivariable analysis, DCAS attendance was associated with more visits in clinics over the first 2 years, less SES and higher median lifetime HbA1c.
Conclusions: SES and less frequent clinic attendance in the first 2 years after diagnosis but not obesity, were predictors of non-uptake of complication screening and are likely to influence the outcome of T1D for these patients. It remains unclear if the non-attenders had medical follow-up at other services.
J. Aulich: None. A.K. Chan: None. J. Cusumano: None. A. Pryke: None. P.Z. Benitez-Aguirre: None. M.E. Craig: None. K.C. Donaghue: None.