Rural/Urban Disparities in the Availability of Diabetes Prevention Programs in US Hospitals

Type 2 diabetes is a global pandemic, with 1 in 6 people expected to be diagnosed by 2050. The Diabetes Prevention Program (DPP) is an evidence-based program that has been shown to reduce A1c and bolster health outcomes in people with type 2 diabetes and prediabetes, but implementation has been varied, with lower uptake in rural and economically underserved communities. The study assessed whether there are geographic and socioeconomic disparities in the availability of hospital-supported DPPs in the US.

We assessed DPPs in 3204 general medical hospitals. Data on hospital and county characteristics came from the American Hospital Association (AHA) Annual Survey, the Area Health Resource File, and County Health Rankings. We assessed geographic and socioeconomic differences between hospitals with and without DPPs using t-tests and chi-square tests. Rurality was determined based on the 2013 Rural-Urban Continuum Codes (RUCC). We then conducted a multivariable analysis to assess the relationship between geographic location, socioeconomic characteristics and the presence of a DPP, independent of hospital factors.

Nearly half (49.3%, n = 1580) of hospitals in the U.S. reported having a DPP in 2021. DPPs were less commonly found in rural counties as well as micropolitan counties when compared to their urban counterparts. After controlling for hospital size and other community characteristics, these disparities disappeared. When including the interaction of hospital size and geographic location, the odds of offering DPPs was higher among large, rural hospitals. DPPs were also less commonly available in counties with more limited food access and in health professions shortage areas.

DPP implementation is less common in rural and underserved areas. The interaction between hospital size and location is helpful for understanding barriers to DPP availability.