Type 1 diabetes outcomes: does distance to clinic matter?


Fox DA, Islam N, Amed S. Type 1 diabetes outcomes: does distance to clinic matter?. Pediatric Diabetes. 2018;19 (7) :1331-6.


Background and Objectives:

To access care, pediatric type 1 diabetes (T1D) patients living in British Columbia (BC), Canada, travel to the sole tertiary pediatric hospital (BC Children's Hospital; BCCH), or they receive community care from pediatric endocrinologists and/or pediatricians. We sought to determine whether HbA1C and patient reported outcomes were associated with (i) distance to clinic and (ii) tertiary vs. community care.


Patients were recruited from T1D clinics across BC. Clinical chart review and patient surveys were completed, including the Diabetes Treatment Satisfaction Questionnaire (DTSQ). Clinic type was categorized as tertiary (BCCH) or community, and travel time to BCCH was categorized as <1 hour (h), 1-2h, or >2h.


There were 189 participants. Age and duration of T1D were similar across groups. Mean number of visits/year for BCCH groups were 2.23, 2.24 and 2.05 for the <1h, 1-2h and >2h groups, respectively, vs. 3.26 for the community group. Adjusted mean difference in HbA1C was +0.65% (95% CI 0.15, 1.15) and +0.52% (95% CI 0.02, 1.02) for the BCCH >2h group compared to BCCH <1h group and community group, respectively. Child DTSQ scores were significantly lower in the BCCH >2h group compared to the BCCH <1h and community groups.


Children travelling >2h to T1D clinic at BCCH had significantly higher HbA1C values and lower satisfaction with care versus those travelling <1h to BCCH and those receiving community care. Access to care closer to home may benefit glycemic control in children with T1D and improve treatment satisfaction. Future research should determine whether these findings can be replicated in other regions.


Publisher's Version

DOI: 10.1111/pedi.12749
Last updated on 08/18/2019