Sociodemographic predictors of follow-up adherence and metabolic control in children with type 1 diabetes: a 2-year retrospective cohort study

Abstract

Abstract Objectives Early metabolic outcomes in children with type 1 diabetes mellitus (T1DM) are shaped not only by clinic follow-up frequency but also by family-level capacity for daily disease management. We evaluated adherence to scheduled outpatient visits during the first 2 years after diagnosis and identified sociodemographic and clinical predictors of adherence and HbA1c-based metabolic control. Methods In this retrospective, single-center cohort study, 150 children with newly diagnosed T1DM who were followed for at least 2 years were studied. Sociodemographic characteristics, family structure, visit frequency, hospitalizations, and serial HbA1c values were extracted from medical records. Adequate adherence was defined as ≥3 visits per year. Results Adherence was high in both the first (97.3 %) and second (91.3 %) years, yet mean HbA1c rose significantly from year 1 to year 2 (6.54 vs. 7.05 %, p<0.001). Sibling count was the only independent predictor of adherence: vs. ≥3 siblings, children with 0–1 siblings (odds ratio [OR] 2.885, 95 % confidence interval [CI] 1.136–7.323, p=0.026), and 2 siblings (OR 3.527, 95 % CI 1.354–9.186, p=0.010) were more likely to attend. Low maternal education was associated with higher hospitalization risk and poorer second-year control (both p<0.001); a family history of diabetes was protective against hospitalization (OR 0.372, 95 % CI 0.164–0.845, p=0.018). Conclusions Despite high clinic attendance, glycemic control deteriorated, indicating that regular attendance alone is insufficient. Family structure and maternal educational capacity appear central to early diabetes trajectories, underscoring the need for family-centered, context-sensitive interventions.