A case control study of diabetic patients who default from primary care in urban New Zealand

Aim: Diabetic patients defaulting from specialist care have worse metabolic control and complications than those attending regularly. We have compared the clinical characteristics of defaulters and more regular health care attenders on a population basis in a multi-ethnic community. Methods: We performed a 2:1 case control study of those defaulting from care for at least 10 months identified from a cross-sectional household survey of known diabetes in inner urban South Auckland, New Zealand. Thirty-seven cases and 52 controls with type 2 diabetes were examined (28 and 36 having retinal photography). Results: Defaulters were less likely to have been damaged by their diabetes (including less severe/proliferative retinopathy 16.7% vs. 0%, respectively, P < 0.05), more likely to have worse foot care (95% vs. 79% poor nail or skin care, P < 0.05) but had similar metabolic control as regular attenders. Most patients could either give no reason for default (40%) or claimed that their diabetes had gone (14%). Twenty-four (65%) reported that nothing could lead them to start attending for diabetes care. Conclusion: We conclude that unlike those defaulting from specialist care, many, but not all, of those with diabetes defaulting from all care generally have comparable metabolic control and less complication than regular attenders. The patients had a range of attitudes to their diabetes suggesting that attracting such patients back into care, prior to a major clinical event or the development of symptoms, is unlikely without major effort.