Hamaker Maya, Schmitt Jessica
Touro College of the Osteopathic Medicine, New York, NY 10027, USA.
University of Alabama at Birmingham Diabetes Research Center, Birmingham, AL 35294, USA.
J Endocr Soc. 2024 Sep 6;8(10):bvae157. doi: 10.1210/jendso/bvae157. eCollection 2024 Aug 27.
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 -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 -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.
糖尿病前期（PD）正变得越来越普遍，而高失访率使管理变得复杂。我们评估了转诊至内分泌科进行评估和管理的小儿PD患者失访状态相关的变量。
我们评估了2017年3月至2021年3月转诊至阿拉巴马州儿童医院内分泌科的新患者。变量包括患者的医疗和人口统计学信息以及县级指标。对于分类变量，通过卡方检验比较复诊患者和失访患者；对于连续正态/偏态变量，分别通过学生t检验/威尔科克森秩和检验进行比较。单因素逻辑回归模型确定失访的危险因素，并报告95%置信区间的比值比以及双侧P值，显著性水平为<.05。
共有524例患者纳入分析。近四分之一的患者失访（24.6%）。参加儿童健康保险计划、正在使用内分泌药物、同时诊断有胆固醇紊乱、在新冠疫情前转诊至内分泌科以及接受远程医疗问诊的患者复诊几率更高。没有其他评估变量与复诊可能性显著相关。
独立于肥胖严重程度、年龄、性别、种族、县级健康和经济变量，与复诊最密切相关的因素是安排了远程医疗问诊。我们的数据表明，提供远程医疗问诊可能会降低该患者群体的失访率。
