Predictors of and barriers to follow-up uptake: analysis of factors and perceived barriers among high-risk individuals with diabetes after screening in China

The objective of this study was to identify variables that predict adherence to follow-up visits among people who are positive for diabetes during screening and to investigate barriers to follow-up. A retrospective cohort study linking individual-level registry data was performed. First, we compared the characteristics of attenders and non-attenders. Second, we investigated perceived barriers using a questionnaire in a random sample of people who failed to attend the follow-up visit. A total of 27,806 (16.4%) patients attended the follow-up visits. Multiple logistic regression analysis revealed that individuals aged ≥75 years were more likely to attend follow-up than were those aged 35–45 years (odds ratio [OR]: 1.97 [95% confidence interval {CI}: 1.82–2.15]), male (OR: 1.15 [95% CI: 1.12–1.18]), obese (OR: 1.36 [95% CI: 1.29–1.43]), had positive family history of diabetes (OR: 1.37 [95% CI: 1.30–1.45]), hypertension (OR: 1.05 [95% CI: 1.01–1.09]), high glucose levels (OR: 1.10 [95% CI: 1.09–1.11]), and high diabetes risk scores (OR: 1.02 [95% CI: 1.02–1.03]) facilitated follow-up. However, overweight (OR: 0.95 [95% CI: 0.92–0.99]) and central obesity (OR: 0.86 [95% CI: 0.83–0.90]) predicted no follow-up. Among nonattenders, diabetes beliefs, time restrictions and distance from home to hospitals were the top three barriers hindering follow-up visits. Specific individual-level characteristics predicted adherence to follow-up visits, and some personal and sociocultural barriers hindered follow-up visits.