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Area of Science:

  • Public Health
  • Epidemiology
  • Health Disparities

Background:

  • Rural America experiences higher rates of diabetes mellitus (diabetes) and related mortality.
  • Diabetes self-management education (DSME) improves glucose control but is less accessible in rural areas.
  • Disparities in DSME access contribute to adverse diabetes outcomes in rural populations.

Purpose of the Study:

  • To determine the proportion of urban versus rural adults who have received DSME.
  • To analyze the impact of reduced DSME availability on diabetes management in rural settings.
  • To identify factors influencing DSME receipt among diverse adult populations.

Main Methods:

  • Cross-sectional study utilizing 2019 Behavioral Risk Factor Surveillance System (BRFSS) data from 29 states.
  • Sample included 28,179 adults with diabetes residing in urban (metropolitan) or rural (non-metropolitan) counties.
  • Logistic regression with survey weights analyzed the odds of DSME receipt based on residence and sociodemographic factors.

Main Results:

  • Overall, 54.5% of participants reported receiving DSME; rural residents (50.4%) had lower rates than urban residents (55.5%).
  • Rural disparities in DSME receipt remained significant after adjusting for covariates (AOR=0.79; 95% CI, 0.71-0.89).
  • Hispanic and single individuals were less likely to report DSME receipt compared to non-Hispanic White and married/coupled individuals.

Conclusions:

  • Significant disparities exist in DSME access between rural and urban populations.
  • Targeted interventions are crucial to address the needs of individuals at risk of missing diabetes educational programs.
  • Efforts to reduce rural diabetes complications must consider and improve access to DSME.