Search Results (75)

Background: Telemedicine complements traditional healthcare delivery and may improve access, continuity of care, and patient engagement, particularly in chronic conditions requiring regular follow-up. Video consultation is a widely adopted telemedicine modality and is increasingly integrated into hybrid care models. Methods: This real-world implementation project describes scheduled video consultations embedded in a hybrid care model for children and adolescents with type 1 diabetes using continuous glucose monitoring (CGM) and integrated insulin delivery technologies as part of routine clinical care. A total of 38 families were offered video consultations as part of routine care; 18 adopted the hybrid model. Video consultations were used for routine follow-up, shared review of device data, treatment adjustment, and diabetes education. Family experience was assessed using a voluntary 5-point Likert-scale satisfaction questionnaire. Complete longitudinal CGM data were available for 13 participants, all of whom were established users of the same automated insulin delivery (AID) platform (MiniMed™ 780G (Medtronic MiniMed, Inc. Minneapolis, MN, USA) integrated with Guardian™ 4 (Medtronic MiniMed, Inc. Minneapolis, MN, USA) continuous glucose monitoring). Results: Between 2022 and 2024, 162 video consultations were conducted. Acceptability was high, with 95% (17/18) of respondents reporting high satisfaction (score ≥ 4 on the 5-point Likert scale). 89% (16/18) of families perceived the quality of care as comparable to face-to-face visits for routine follow-up. Families highlighted convenience, reduced travel burden, and flexibility, as well as the value of shared review of CGM and AID system data. Group-level CGM-derived metrics appeared descriptively similar across sequential face-to-face visits and video consultations. Individual patient trajectories showed expected variability but no consistent pattern of deterioration during periods of remote follow-up. Conclusions: Video consultation is a feasible and well-accepted complementary modality within hybrid care models for pediatric type 1 diabetes. When integrated with CGM and automated insulin delivery systems, it supports personalized, data-driven clinical decision-making and continuity of care. Structured implementation and systematic evaluation are essential for sustainable integration into routine practice. Full article

Background: Effective communication with patients is vital for improving health outcomes in chronic disease management. In this study, we investigated WoundScribeAI’s Scribe AI, also known as Ambient Technology, and its patient education and engagement app, Pingoo.AI. It employed a multi-agent AI model that leveraged Large Language Models (LLMs) and NotebookLM to enhance patient communication in clinical settings. Methods: The system comprised specialized agents that transcribed healthcare provider–patient conversations through ambient dictation. This transcription generated medical notes that followed the Subjective, Objective, Assessment, and Plan (SOAP) format—a structured document used by healthcare providers to record and communicate information about patient encounters. Simultaneously, comprehensive visit summaries were also created. In the next step, these visit summaries were used to produce conversational and educational content by leveraging NotebookLM, an AI model introduced by Google that can generate podcast-style conversations from provided information. Integrating these agents allows clinicians to deliver engaging, empathetic, and actionable information to patients. Medical experts conducted a two-phase evaluation of the system’s performance based on multiple criteria, with a particular focus on diabetes education and diabetic foot care. The first phase used pre-recorded training videos, while the second phase involved simulated consultations by clinicians using the system. To validate the AI-generated educational content, we used several established frameworks in health communication that closely align with our enhancement goals. Results: The results showed that the AI model generated accurate clinical documentation and met the criteria for accurate SOAP Notes, visit summaries, and engaging educational content for patients. Given that hallucination is a significant concern related to large language models, especially in critical fields like healthcare, we meticulously analyzed the generated outputs to identify any signs of hallucinated information. Three outcomes successfully passed the validation criteria, including accuracy, completeness, comprehensiveness, absence of potential harm, and no hallucination. Additionally, the Conversational Education content was confirmed against established patient education frameworks and met criteria such as the use of metaphors, empathetic tone, and appropriate language, providing additional detail to help manage the condition. Conclusions: By providing specific instructions and prompts to NotebookLM to transform visit summaries into educational conversations, we significantly enhanced the comprehensiveness and engagement of the content for patients. In contrast to a traditional summary of the clinical visit, the podcast-style conversation enriched the content with background information, encouraging language, an empathetic tone, and helpful metaphors. Our analysis confirmed that the system did not exhibit any hallucinations, highlighting the effectiveness of our approach in mitigating this risk. These findings support the use of multi-agent AI models, combined with ambient dictation and tools like NotebookLM, to improve patient communication that surpasses traditional paper-based brochures, which are often impersonal, minimal, and do not always adhere to recommended factors for health literacy. Full article

Non-communicable diseases, particularly cardiovascular diseases (CVD) and metabolic syndrome (MS), remain a major challenge for primary health care (PHC). This study aimed to assess cardiometabolic risk and health behaviours in adult PHC patients using routine preventive screening. This prospective observational study included 506 adults attending routine consultations in an urban PHC centre in Poland. Preventive assessment included anthropometric measurements (body weight, height, BMI, and waist circumference), blood pressure, lipid profile, and fasting glucose levels. Health behaviours were recorded using the standardised NFZ CHUK questionnaire. The 10-year CVD risk was estimated using the SCORE2 algorithm. Multivariable logistic regression was used to identify independent factors associated with high cardiovascular risk (SCORE2 ≥ 5%) and of a composite endpoint defined as the presence of any non-optimal biochemical parameter. Nearly half of the participants had excess body weight (overweight or obesity), and more than half met criteria for central obesity. Borderline or elevated total cholesterol was found in 47% of patients, abnormal LDL in 27%, low HDL-C (<40 mg/dL) in 80% (84% when applying sex-specific cut-offs), and impaired fasting glucose or diabetes in about 12%. High SCORE2 risk (≥5%) was observed in approximately 9% of the cohort. In multivariable models, SCORE2 components (age, sex, and smoking) were, as expected, associated with high SCORE2 risk, and obesity (BMI ≥ 30 kg/m²)—a factor not included in SCORE2—was additionally associated with higher risk. Additionally, age, male sex, and obesity also predicted the presence of at least one non-optimal biochemical marker. The prevalence of high SCORE2 risk increased from 1.2% in patients with 0–1 modifiable risk factor to 25.7% in those with 4–5 factors. Lower educational attainment was associated with a higher proportion of high-risk individuals in univariate analysis. Routine preventive activities in PHC enable the identification of important lipid and glucose abnormalities and the clustering of modifiable risk factors, even in a relatively young, highly educated population. Systematic cardiovascular screening and a focus on patients with accumulated risk factors should remain a priority in PHC to enable early identification of high-risk patients and timely implementation of lifestyle and therapeutic interventions. Full article

Background: Chronic diseases such as type 2 diabetes mellitus and cardiovascular disease and their cardiometabolic risk factors require management, which includes lifestyle interventions. Rural and remote residents are disproportionately affected by these conditions compared to their urban counterparts. Studies have examined barriers to chronic disease and cardiometabolic risk factor management in urban environments, but rural perspectives remain underexplored, especially in Western Australia (WA) with its vast geography. This study examined rural general practitioners’ (GPs) views on barriers and facilitators to chronic disease and cardiometabolic care in rural WA through lifestyle management. Methods: This qualitative study used semi-structured interviews with 15 rural WA GPs recruited via rural networks using convenience and snowball sampling. Braun and Clarke’s reflexive thematic analysis was used to identify patterns and themes within the qualitative data that addressed the study questions. Results: According to rural general practitioners, major barriers to chronic disease and cardiometabolic risk care included geographic isolation, socioeconomic disadvantage and an obesogenic food environment in rural areas, as well as severe time and financial constraints for GPs and workforce shortages with a high turnover and lack of accessible allied health professionals. Facilitators included co-located multidisciplinary teams, case management/health coaching, better remuneration for complex consultations involving preventive care and upstream policy measures, such as improving healthy food affordability and availability. Conclusion: Rural patients face systemic, geographic and socioeconomic barriers that are substantially greater than those in urban settings; these barriers impact GPs caring for their patients with chronic disease and cardiometabolic risk factors. Targeted solutions to these barriers such as attention to workforce issues, investment in lifestyle coaching approaches and having dedicated case managers, could reduce rural–urban inequities in chronic disease outcomes. Full article

Background: There is a limited amount of evidence concerning the association between seasonal variation and the level of physical activity in individuals with chronic disease. This longitudinal observational study aimed to explore seasonal, monthly, and holiday variations in self-monitored step counts over two years among adults with prediabetes and type 2 diabetes in Sweden. Methods: Participants were recruited at primary care centers from 2013 to 2018 to take part in a physical activity intervention. Inclusion criteria included the following: an age of 40–80 years, having prediabetes or type 2 diabetes (≥1 year), and the ability to communicate in Swedish. Individuals with recent myocardial infarction, impaired renal function, diabetic ulcers, a limited capacity for physical activity, insulin onset (<6 months), recurrent or severe hypoglycemia, a high baseline for physical activity, or no internet access were excluded. In total, 120 participants wore step counters and recorded daily steps for two years. Linear mixed models adjusted for sex, age, and body mass index were applied. Results: Mean (95% CI) step counts were statistically significantly higher in summer (7825 [7762, 7889]) and spring (7805 [7757, 7853]) compared to winter (7098 [7052, 7145]) and fall (7422 [7349, 7490]). Highest step counts were registered in May (7993 [7904, 8071]), followed by June (7968 [7895, 8063]), and the lowest in January (6944 [6856, 7034]) and November (7208 [7113, 7289]). Step counts during holiday periods were statistically significantly lower than non-holiday periods across all seasons. Conclusion: Self-monitored daily steps varied over the seasons in this sample of individuals with prediabetes and type 2 diabetes. Declined physical activity levels in months with unfavorable weather conditions require attention in consultations and research. Full article

Background: The emergence of telehealth has transformed healthcare delivery across multiple disciplines, with tele-nutrition representing a rapidly evolving field that addresses nutritional assessment, counseling, and management through digital platforms. Objective: This narrative review examines the current landscape of pediatric tele-nutrition services, exploring technological platforms, clinical applications, evidence for effectiveness, implementation considerations, and future directions. Methods: A comprehensive literature search was conducted across PubMed, CINAHL, Embase, and Web of Science databases from January 2010 to October 2025. A total of 114 relevant sources were selected, encompassing randomized controlled trials, observational studies, systematic reviews, implementation studies, clinical guidelines, and policy documents. Results: This review synthesized 114 sources, predominantly from the United States (54%) and European nations (21%), with evidence expansion accelerating post-COVID-19 pandemic. Evidence suggests pediatric tele-nutrition demonstrates clinical outcomes comparable to traditional in-person care across diverse populations including obesity management, diabetes, gastrointestinal disorders, feeding difficulties, metabolic conditions, and preventive nutrition services. Multiple technology platforms are utilized, with synchronous video consultations most common (60–85% of encounters). Benefits include enhanced access to specialized care, increased frequency of contact, reduced family burden, and high satisfaction rates (>80% across most studies). Challenges include limitations in physical assessment, digital equity concerns affecting vulnerable populations, variable reimbursement policies, and the need for provider training. Hybrid models combining virtual and in-person care appear optimal for many conditions. Conclusions: Pediatric tele-nutrition represents a viable and effective care delivery model with particular advantages for families facing geographic, logistic, or access barriers. Continued attention to digital equity, provider training, regulatory frameworks, sustainable reimbursement policies, and rigorous evidence generation will optimize implementation and outcomes. Future directions include artificial intelligence applications, precision nutrition approaches, and expanded global health applications. Full article

Background: Over the past several decades, the prevalence of gestational diabetes mellitus (GDM) has risen markedly worldwide, posing serious threats to both maternal and child health by increasing adverse pregnancy outcomes and long-term metabolic risks. Developing effective risk prediction tools for early detection and intervention has become the most important clinical priority in this field. The current GDM prediction models primarily rely on non-modifiable factors, for example age and body mass index, while modifiable factors such as lifestyle and health literacy, although strongly associated with GDM, have not been fully utilized in risk assessment. This study sought to establish and validate a nomogram prediction model combining modifiable and non-modifiable risk factors, with the goal of identifying high-risk Chinese pregnant women with GDM at an early stage and promoting targeted prevention and personalized prenatal management. Methods: A multicenter study was conducted across 7 maternal health institutions in Southern China (2021–2023), enrolling 806 singleton pregnant women (14–23⁺⁶ weeks). The collected data included sociodemographic, clinical history, and modifiable factors collected through validated questionnaires: dietary quality, physical activity level, sleep quality, and nutrition and health literacy. GDM was diagnosed via 75 g oral glucose tolerance test at 24–28 weeks. Predictive factors were identified through multi-variable logistic regression. A nomogram model was developed (70% modeling group) and validated (30% validation group). Receiver operator characteristic curves, calibration curves, and decision curve analysis were used to evaluate the prediction ability, the degree of calibration, and the clinical benefit of the model, respectively. Results: The finalized risk prediction model included non-modifiable factors such as maternal age, pre-pregnancy weight, and maternal polycystic ovary syndrome, as well as modifiable factors including dietary quality, physical activity level, sleep quality, nutrition and health literacy. The application of the nomogram in the modeling group and the validation groups showed that the model had high stability, favorable predictive ability, good calibration effect and clinical practicality. Conclusions: Overall, the integrated model demonstrates significant clinical utility as it facilitates the prompt identification of individuals at heightened risk and offers actionable targets for personalized interventions. In terms of future implementation, this model can be integrated into prenatal care as a rapid scoring table during early pregnancy consultations or incorporated into mobile health applications. This approach fosters precise prevention strategies for GDM in maternal health by emphasizing nutrition and health literacy, supplemented by coordinated adjustments in diet, physical activity, and sleep. Full article

Background: Refugees often face major health challenges owing to displacement, poor living conditions, limited access to healthcare, and the psychological toll of forced migration. Access to healthcare has been a major concern because of disrupted medical services, pre-existing health conditions, and integration challenges in host countries. This study aimed to evaluate the effect of infectious diseases on refugees in the context of the war in Ukraine by analyzing data from patients who accessed health services from a county hospital. Methods: We analyzed the data of Ukrainian refugees who presented for an infectious disease between February 2022 and March 2025 in the largest hospital unit in Romania located immediately near the border with Ukraine. Results: A total of 2052 refugee patients of Ukrainian nationality presented to the Emergency Reception Unit of “St. Ioan cel Nou Suceava” for consultations; 672 patients required an evaluation by an infectious disease specialist and 48 were hospitalized in the Department of Infectious Diseases. The most common disease encountered in children was influenza, whereas the most common disease in adults was SARS-CoV-2 infection. The most frequently encountered comorbidities in pediatric patients were anemia (26.9%) and dehydration syndrome (46.2%). In adults, comorbidities included chronic obstructive pulmonary disease (18.2%), hypertension (13.6%), chronic coronary disease (4.5%), diabetes (9.1%), and chronic hepatitis (4.5%). Patients were treated with antivirals, rehydration solutions or only symptomatic treatment. Conclusions: Romania is implementing public health measures to address these challenges, focusing on vaccination and disease screening, and ensuring access to essential healthcare services. These services include access to primary care physicians, specialist consultations, hospitalization, and essential medications. Full article

Background: Vision loss due to chronic eye diseases remains a significant public health challenge. Early detection through screening programs may reduce the burden of vision loss. This study aimed to assess the detection rate of eye diseases (glaucoma, AMD, and diabetic retinopathy), including those newly detected during opportunistic screening and ophthalmological consultations within the local government health policy program “Good Vision for Mazovians” in Mazovia, Poland. Material and methods: This study is a retrospective analysis of medical data from the registry of the Ophthalmology Department of the Międzylesie Specialist Hospital in Warsaw, which implemented the local government preventive program “Good Vision for Mazovians. Data from 1812 individuals (aged 18–92 years) participating in the “Good Vision for Mazovians” preventive program were analyzed. Results: Most participants were female (59.7%), aged over 60, and took medications regularly (62.7%). Excluding subjects with prior diagnosis of eye conditions, the detection rate was 38 suspected cases (3.8%) of glaucoma cases, 84 suspected cases of AMD (4.6%), and 21 suspected cases of diabetic retinopathy (1.2%). Most participants had not visited an ophthalmologist in the past two years (58.6%), reported low or average knowledge of eye health, had difficulty accessing ophthalmology services in their region (57%), and identified long waiting times for appointments as the main barrier to care (83.5%). Conclusions: Opportunistic screening for eye diseases in populations with limited access to eye care should be considered as a method for detecting common causes of irreversible visual impairment, particularly AMD. Older adults and individuals without higher education appear to face the greatest barriers to accessing ophthalmology services and may benefit the most from targeted opportunistic screening initiatives. Full article

Background: Minority disparities have been documented in the diabetic community since the late 1990s. Historically, the literature acknowledges that higher rates of diabetes-related complications occur in this subgroup. Despite this, disparities among patients with Charcot’s neuroarthropathy have yet to be explored. We compared incidence and management among patients with Charcot’s neuroarthropathy with emphasis on racial and geographic differences. Methods: We retrospectively reviewed patients from two hospitals, an inner-city tertiary center and a suburban facility, between 2013 and 2022. Patients were managed by the same attending physician as either referrals or initial consultations for a diagnosis of Charcot’s neuroarthropathy of the foot and ankle. Patient selection was performed via International Classification of Diseases, 10th Revision codes associated with Charcot’s joint of the foot. Results: Of 120 patients identified, 87.5% were nonminority white individuals. The minority community had an increased frequency of medical comorbidities. Minorities were two times more likely to undergo a staged reconstruction. Compared with suburban patients, inner-city patients, on average, had higher hemoglobin A1c levels and more ulceration and osteomyelitis. Similarly, this cohort was more apt to undergo reconstructive surgery and had a reduced mortality rate. Conclusions: Although there may be a correlation with medical comorbidities in minority communities, there does not seem to be a difference in the management of Charcot’s neuroarthropathy. Location has the potential to play a role in diagnosis, management, and potential outcomes, likely due to access to health care and community education. More prospective studies are warranted to better understand the influence of racial and geographic differences on management of the Charcot foot. Full article

Background: Telepharmacy, the provision of patient care services by pharmacists through the use of telecommunications technology, is associated with improved diabetes-related outcomes and access to healthcare. The primary aim of this study was to characterize pharmacists’ interventions at a virtual pharmacist-led diabetes clinic (PLDC). The secondary aim was to assess the feasibility of conducting a future cost-effectiveness study of the PLDCs. Methods: This prospective observational feasibility study was conducted within a pharmacist-led clinic at Seha Virtual Hospital, Riyadh, Saudi Arabia. Two intern pharmacists collected data between 31 July 2024 and 31 January 2025. Results: Seventy-five patients (mean [SD] age 50.47 years [14.95]) attended the clinic. The majority were female (58.7%), had type 2 diabetes (86.6%), and were from outside Riyadh (97.3%). The communication with patients was carried out mainly via telephone (73, 97.3%). The mean consultation duration was 7.64 min (SD = 5.68). A total of 179 interventions were conducted, with a mean number of interventions per patient of 2.5 (median 3, min 0, max 5). The most common intervention was patient education and counseling about their disease and medications. While it was feasible to capture the details of pharmacist interventions and resource use data, incomplete data on patient outcomes presented a challenge. Conclusions: Our detailed documentation of pharmacist–patient encounters revealed the ability of pharmacists to identify and manage the problems of diabetes patients at virtual PLDCs. Our feasibility study identified a few challenges that need to be addressed when designing future cost-effectiveness studies. Full article

Objectives: To investigate the demographic, epidemiological, and medical profiles of hospitalized COVID-19 patients who received dental care, and to identify their main oral health needs. Methods: This retrospective, descriptive cohort study analyzed medical and dental records of patients hospitalized with COVID-19 at a private tertiary hospital in São Paulo, Brazil, from January 2020 to March 2022. The data collected included demographic variables, comorbidities, length of hospitalization, need for respiratory support, clinical outcomes, dental diagnoses, and procedures performed. Results: A total of 129 medical records were reviewed. The sample included 93 males (72%) and 36 females (28%), with a mean age of 72 years. Comorbidities were present in 92% of cases, most frequently a prior COVID-19 infection (59%), diabetes (36%), and depression (31%). The mean hospital stay was 51 days, with a median of 33 days. Most patients (91%) required ICU care; among these, 87% received invasive mechanical ventilation. Dental consultations were most commonly requested for oral assessments (88%), lesions (58%), and opportunistic infections (8%). The most frequent diagnoses were trauma-related lesions from orotracheal intubation (63%), opportunistic infections (45%), and odontogenic or periodontal infections (15%). Primary treatments included oral hygiene procedures (89%), photobiomodulation therapy (67%), and tooth extractions (6%). Patients received an average of eight dental consultations. The overall mortality rate was 26%. Conclusions: Older male patients with COVID-19 frequently required intensive dental care during hospitalization. Oral trauma and opportunistic infections were common, highlighting the need for specialized dental management in critically ill populations. Full article

Tuberculosis (TB) remains a leading cause of death in Bangladesh, disproportionately affecting low socio-economic status (SES) populations. This review, guided by the WHO Social Determinants of Health framework and Rockefeller-Lancet Planetary Health Report, examined how social, economic, and ecological factors link SES to TB burden. The first literature search identified 28 articles focused on SES-TB relationships in Bangladesh. A second search through snowballing and conceptual mapping yielded 55 more papers of diverse source types and disciplines. Low-SES groups face elevated TB risk due to smoking, biomass fuel use, malnutrition, limited education, stigma, financial barriers, and hazardous housing or workplaces. These factors delay care-seeking, worsen outcomes, and fuel transmission, especially among women. High-SES groups more often face comorbidities like diabetes, which increase TB risk. Broader contextual drivers include urbanisation, weak labour protections, cultural norms, and poor governance. Recommendations include housing and labour reform, gender parity in education, and integrating private providers into TB programmes. These align with the WHO End TB Strategy, UN SDGs and Planetary Health Quadruple Aims, which expand the traditional Triple Aim for health system design by integrating environmental sustainability alongside improved patient outcomes, population health, and cost efficiency. Future research should explore trust in frontline workers, reasons for consulting informal carers, links between makeshift housing and TB, and integrating ecological determinants into existing frameworks. Full article

Background/Objectives: The COVID-19 pandemic exposed critical vulnerabilities in healthcare systems, especially in ensuring continuity of care for patients with chronic diseases. Rehabilitation services, essential for recovery following SARS-CoV-2 infection, were among the most disrupted. This exploratory study aimed to assess Romanian patients’ perceptions of the accessibility and quality of post-COVID-19 rehabilitation services, focusing on individuals with chronic conditions. Methods: This exploratory cross-sectional study was conducted over a 12-month period in 2024. Data were collected from 76 adult patients diagnosed with at least one chronic condition (hypertension, diabetes mellitus, ischemic heart disease, cancer, or chronic obstructive pulmonary disease) and with confirmed prior SARS-CoV-2 infection. Most participants were recruited during outpatient specialty consultations, with a smaller number included from hospital settings, all located in Bucharest. A structured questionnaire was administered by the principal investigator after obtaining informed consent. Quantitative data were analyzed using non-parametric methods following confirmation of non-normal distribution via the Shapiro–Wilk test (p < 0.05). Satisfaction scores were reported as medians with interquartile ranges (IQR), and group comparisons were performed using the Mann–Whitney U test. A mixed-methods approach was employed, including thematic analysis of open-ended responses. Results: Patient satisfaction with rehabilitation services was consistently low. The median satisfaction scores [IQR] were accessibility 1.0 [0.0–2.0], quality of services 0.0 [0.0–4.0], staff empathy 0.0 [0.0–5.0], and perceived effectiveness 0.0 [0.0–5.0]. The median score for perceived difficulties in access was 1.0 [1.0–2.0], indicating widespread barriers. No statistically significant differences were observed between urban and rural participants or across chronic disease categories. Thematic analysis (n = 65) revealed key concerns including lack of publicly funded services, cost barriers, limited physician referral, service scarcity in rural areas, and demand for home-based rehabilitation options. Conclusions: Romanian patients with chronic illnesses and previous SARS-CoV-2 infection continue to face substantial barriers in accessing post-COVID-19 rehabilitation services. These findings highlight the need for more equitable and integrated recovery programs, especially for vulnerable populations in underserved settings. Full article

Background/Objectives: Nonattendance at healthcare appointments remains a major challenge, particularly in chronic diseases like diabetes. Dietary therapy is essential in diabetes care, yet nonattendance at dietitian appointments persists. This study aimed to identify key drivers of nonattendance at dietitian appointments, explore prior experiences with dietary counseling, and determine factors motivating attendance. Methods: A mixed-methods approach was used in this quality improvement project, drawing on multiple data sources to explore nonattendance at dietitian appointments. This included combining a retrospective analysis of clinical and attendance data from patient records at a Danish outpatient diabetes clinic with semi-structured interviews with 25 individuals who had recently missed a dietitian appointment. Quantitative and qualitative data were analyzed separately and then integrated to characterize overall nonattendance patterns. Interview data were analyzed using systematic text condensation. Results: Individuals who missed dietitian appointments were also more likely to miss other healthcare appointments. Vulnerable individuals (i.e., those with complex health conditions or mental health issues) were more likely to miss appointments. Four principal barriers to attendance were identified: administrative, digital, and logistical challenges; competing health concerns; personal priorities; and unclear referral communication and patient involvement. Conclusions: Improving attendance at dietitian appointments requires a multifaceted approach. Key recommendations include optimizing scheduling practices, implementing digital reminders, offering continuity of care and virtual consultation options. Referring clinicians should improve patient communication by clearly explaining the purpose of the dietitian consultation and involving patients in shared decision-making prior to referral. Dietitians should collaborate with patients to establish realistic, personalized goals to foster engagement in their diabetes management. Full article