Type 1 diabetes outcomes: Does distance to clinic matter?

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 hemoglobin A1C (HbA1C) and patient‐reported outcomes were associated with (1) distance to clinic and (2) tertiary vs community care. Methods 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 the travel time to BCCH was categorized as 2 hours. Results 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 2‐hour groups, respectively, vs 3.26 for the community group. Adjusted mean difference in HbA1C was +0.65% (95% confidence interval [CI]: 0.15, 1.15) and +0.52% (95% CI: 0.02, 1.02) for the BCCH >2‐hour group compared to the BCCH 2‐hour group compared to the BCCH 2 hours to T1D clinic at BCCH had significantly higher HbA1C values and lower satisfaction with care vs those traveling