Azova Svetlana, Lennerz Belinda S, Petty Carter R, Gordon Erin, Michelson Hannah, Schmidt Anna, Garvey Katharine, Rhodes Erinn T
Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston 02115, Massachusetts, USA.
Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston 02115, Massachusetts, USA.
Pediatr Diabetes. 2025;2025. doi: 10.1155/pedi/4108685. Epub 2025 Mar 28.
Diabetes organizations recommend nutrition education by a registered dietitian (RD) at least annually following type 1 diabetes (T1D) diagnosis in children. The study objectives were to describe differences over time in annual RD follow-up in children with T1D and to identify patient characteristics associated with RD engagement.
Data based on 6034 completed diabetes medical visits among 1982 patients aged <18 years with T1D for ≥1 year followed at a pediatric, tertiary care, academic medical center over a 5-year period (2018-2022) were analyzed. Generalized estimating equations models assessed for differences over time in the rates of RD visit completion in the year preceding the last diabetes medical encounter and identified sociodemographic, diabetes care-related, and clinical patient characteristics associated with RD follow-up. Models were fit for the whole sample and groups subset by race and ethnicity.
Observed annual RD follow-up rate over the 5-year period was 20.8%, with the lowest adjusted percentage in 2021 compared to 2018. In multivariable analysis, for each year increase in age ( = 0.004) and diabetes duration (<0.001), there was a 3% and 15% reduction in the odds of RD follow-up, respectively. RD follow-up was associated with lower hemoglobin A1c within the subsequent year in adjusted analysis ( = 0.029), with the greatest improvement among Hispanic patients.
Annual RD visit frequency among children with T1D is suboptimal. Study findings provide insights for targeted intervention to improve RD engagement. RD follow-up may be associated with improved glycemic outcomes.
糖尿病组织建议，儿童1型糖尿病（T1D）确诊后，至少每年由注册营养师（RD）进行营养教育。本研究的目的是描述T1D儿童每年接受RD随访的时间差异，并确定与RD参与相关的患者特征。
分析了1982例年龄<18岁、患有T1D且病程≥1年的患者在一家儿科三级医疗学术中心5年期间（2018 - 2022年）完成的6034次糖尿病医疗就诊数据。广义估计方程模型评估了在最后一次糖尿病医疗就诊前一年中RD就诊完成率随时间的差异，并确定了与RD随访相关的社会人口统计学、糖尿病护理相关和临床患者特征。模型适用于整个样本以及按种族和民族划分的亚组。
5年期间观察到的年度RD随访率为20.8%，与2018年相比，2021年调整后的百分比最低。在多变量分析中，年龄每增加一岁（ = 0.004）和糖尿病病程每增加一年（<0.001），RD随访的几率分别降低3%和15%。在调整分析中，RD随访与次年较低的糖化血红蛋白相关（ = 0.029），西班牙裔患者的改善最为显著。
T1D儿童的年度RD就诊频率未达最佳水平。研究结果为改善RD参与度的针对性干预提供了见解。RD随访可能与改善血糖结果相关。
