Dropout and Relapse During Diabetes Care
- Alan L Graber, MD,
- Patricia Davidson, RD, MS,
- Anne W Brown, RNC, MSN,
- John R McRae, MD and
- Kathleen Woolridge, RNC, MSN
- Department of Internal Medicine, Vanderbilt University School of Medicine and School of Nursing Nashville, Nashville, Tennessee
- Address correspondence and reprint requests to Alan L. Graber, MD, St. Thomas Medical Plaza East, 4230 Harding Road, Suite 527, Nashville, TN 37205.
OBJECTIVE To determine factors associated with dropout and relapse during chronic diabetes care.
RESEARCH DESIGN AND METHODS Private practice outpatient treatment-education program for adult diabetes was surveyed. Retrospective analysis was done, involving 422 patients for up to 3 yr.
RESULTS Of the patients in the study, 12% dropped out after the initial visit, and 33% of the residual cohort dropped out during each subsequent 6-mo period. Factors associated with dropout included distance from home to clinic > 100 miles, lack of insulin treatment, and cigarette smoking. In patients who remained in follow-up, a significant decrease in HbA1C occurred during the first 6 mo, but 40% of the patients relapsed between 6 and 12 mo. Frequency of relapse declined as time passed. Relapse was more frequent in women.
CONCLUSIONS Dropout from treatment and relapse after temporary improvement account for a substantial amount of uncontrolled diabetes, and overcoming the obstacles of dropout and relapse has potential for significant improvement in diabetes care.
- Received October 10, 1991.
- Revision received July 9, 1992.
- Accepted July 9, 1992.
- Copyright © 1992 by the American Diabetes Association