Association between Glycemic Control and Visits with Diabetes Care Team in Youth with Type 1 Diabetes

Abstract

Clinical care of youth with type 1 diabetes (T1D) involves a multidisciplinary team including diabetes provider, registered dietitian (RD), certified diabetes educator (CDE), and social worker (SW) or psychologist. There is limited evidence to guide the ADA recommendations for visit frequency, so this study sought to evaluate the association between visit frequency and glycemic control. A cross-sectional analysis of demographic, clinical, and visit frequency data was performed from 1,995 T1D youth with diabetes duration ≥ 1 year, and ≥ 1 diabetes clinic visit during a 1-year period at a pediatric diabetes center. Patient demographics included 50.6% female, age 13.9±4.2 years, T1D duration 6.3±4 years, HbA1c 8.6±1.8%, and race/ethnicity: 52.4% white, 23.4% Hispanic, 16.7% black, and 7.7% other. The cohort averaged 2.9±1.3 annual provider visits. Patients with 3 or 4 annual provider visits had statistically lower mean HbA1c than those with 1, 2, or ≥ 5 visits (Figure 1). In total, 43.6% attended ≥1 CDE, 50.5% RD, and 71.8% SW/psychology visit. Seeing a CDE, RD, or SW/psychologist was not associated with lower HbA1c among the overall cohort, but was associated with lower HbA1c among privately insured patients. These findings reflect the complex, multidimensional nature of T1D management. Further investigation into clinical, psychosocial, and patient-reported outcomes beyond glycemic control is warranted. Disclosure K. Travis: None. A. Jones: None. S. Lyons: None. D.J. DeSalvo: Consultant; Self; Dexcom, Inc.. Speaker's Bureau; Self; Insulet Corporation.