Diabetes in Rural & Minority Communities

Data from the UKPDS study has clearly shown that improving glycemic and blood pressure control in patients with diabetes can result in significant reductions in both morbidity and mortality (see UKPDS 1998). The American Diabetes Association and other entities have published guidelines for diabetes care based on this and other evidence (see American Diabetes Association, 2007). However, many patients, particularly rural minority patients, do not receive these recommended levels of care, demonstrating the need for redesigning systems of care to minimize long-term morbidity/mortality.

Rural minority patients with Type 2 diabetes mellitus are a vulnerable population.

Age adjusted mortality rates for diabetes in the predominantly rural state of North Carolina (NC) are 2.2 times higher for minority males and almost 3 times higher for minority females than their white counterparts. In rural eastern NC the adjusted mortality rate from diabetes is 42% higher than the rest of the state. Further, Dansky et al (1998) demonstrated that Medicare beneficiaries with diabetes mellitus in rural communities reported fewer physician office visits than urban patients while others have shown that low income, rural patients with diabetes are more likely to receive care from a primary care physician than from a specialist (McCall et al 2004, Woodwell et al 2004).

Patients in rural primary care practices have diabetes outcomes that are inadequate relative to published guidelines.

In studies in both the United States (see Andrus et al 2004, Zoorob et al 1996, McCall et al 2004) and Canada (Toth et al 2003), it has been shown that diabetes care in rural areas is inadequate relative to the standards described by the American Diabetes Association (ADA) and often is of lower quality than that in urban settings. In a study by Andrus et al (2004) of a representative sample (n = 187) of rural and urban patients with diabetes mellitus in Alabama, rural patients had lower quality outcomes in every category studied. In a study by Coon et al (2002), and in additional rural studies by Porterfield and Kinsinger (2002) and Bell et al (2001), hyperglycemia among rural patients was also less well controlled relative to published guidelines.

The following slides demonstrate the fact that rural Eastern North Carolina and minority patients have diabetes outcomes that are inadequate relative to published guidelines.

Our Burden of Obesity and Diabetes (2009)


NC Diabetes Mortality and Disparity by Ethnicity (2004-2008)


Regional Disparity - Diabetes Mortality

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