Diabetes Care and Outcomes: Disparities Across Rural America

Abstract

We examined differences in receipt of diabetes care and selected outcomes between rural and urban persons living with diabetes, using nationally representative data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS). "Rural" was defined as living in a non-metropolitan county. Diabetes care variables were physician visit, HbA1c testing, foot examination, and dilated eye examination. Outcome variables were presence of foot sores and diabetic retinopathy. Analysis was limited to persons 18 and older self-reporting a diagnosis of diabetes (n = 29,501). A lower proportion of rural than urban persons with diabetes reported a dilated eye examination (69.1 vs. 72.4%; P = 0.005) or a foot examination in the past year (70.6 vs. 73.7%; P = 0.016). Conversely, a greater proportion of rural than urban persons reported diabetic retinopathy (25.8 vs. 22.0%; P = 0.007) and having a foot sore taking more than four weeks to heal (13.2 vs. 11.2%; P = 0.036). Rural residence was not associated with receipt of services after individual characteristics were taken into account in adjusted analysis, but remained associated with an increased risk for retinopathy (OR = 1.20, 95% CI = 1.02-1.42). Participation in Diabetes Self-Management Education (DSME) was positively associated with all measures of diabetes care included in the study. Availability of specialty services and travel considerations could explain some of these differences.

Diabetes Self-Management Interventions for Adults with Type 2 Diabetes Living in Rural Areas: A Systematic Literature Review

“…Individuals living with T2DM in rural areas face multiple challenges, including lack of access to diabetes education [8] and clinical services [9], limited cell phone coverage and internet access [10], limited transportation and long travel distances [5], as well as higher rates of poverty [11]. These challenges in turn contribute to suboptimal diabetes management and higher rates of diabetes-related complications [9, 12•]. …”

The Role of Mutual Support Groups for the Control of Diabetes in a Mexican City: Achievements and Limitations from the Patients’ Perspective

“…There were positive remarks in terms of treatment adherence, metabolic control, and coping with the disease as other authors have reported [22], which translated into an improved quality of life.…”

“…This approach has proven successful encouraging patients to incorporate lifestyle changes, and even motivating participants to continue attending meetings after completing the program and despite transportation barriers [22].…”

Design of a Rural Diabetes Self-Directed Care Program

“…Primary care physicians manage approximately 90% of diabetes clinical care in generalist clinics. The percentage is even higher in rural areas (Hale, Bennett, & Probst, 2010). Caring for diabetes in the clinic requires expertise with a foundation in biology, and outside the clinic, caring for diabetes requires separate expertise with a foundation in community 776 D. Rugh organization and social learning theory.…”

“…Often, educational classes in hospitals are the only support for rural primary care clinics. These hospital classes have high barriers of access and limited potential for behavioral change (Hale, Bennett, & Probst, 2010;Siminerio, Piatt, & Zgibar, 2005). The self-directed care program delineated in this article was developed for patients in rural communities, who receive diabetes care at primary care clinics.…”