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Daily Dose: Disparities in Diabetes Care


Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On May 26, 2023, we reported on a study published in Annals of Family Medicine that compared patient-level measures of the quality of diabetes care between rural and urban patients in a large health care system.

The study

Researchers conducted a retrospective cohort study assessing patients’ attainment of the D5 metric, a diabetes care metric having 5 components: no tobacco use, glycated hemoglobin (A1c) level <8%, blood pressure <140/90 mm Hg, low-density lipoprotein (LDL) cholesterol level at goal or statin prescribed, and aspirin use consistent with clinical recommendations. Investigators also collected outpatient, endocrinology, diabetes education, and nutrition visits for the year.

A total of 45 279 patients with type 2 diabetes were enrolled in the study, of whom 54.4% resided in rural locations.

The findings

The results showed that 39.9% of rural patients attained all 5 goals, compared with 43.2% of urban patients. Among the various elements of the D5 metric, the largest difference was in LDL cholesterol level or statin prescribed, with 86.5% of urban residents meeting the goal vs 84.1% of rural residents,

Regardless of residence location women, older patients, and patients with less complexity had the highest odds of attaining all 5 goals. Patients were less likely to achieve all 5 if they had at least 1 diabetes education or endocrinology visit. The latter association, the authors say, is not surprising given that patients generally are referred to specialists when they aren’t meeting glycemic goals. They explain the lower frequency of care among rural residents by citing results of earlier studies suggesting that distance is a barrier to care, especially when the care is seen as routine.

Note from authors

"This study highlights the need for further large, pragmatic trials of innovative health care delivery approaches tailored to overcome the obstacles faced by our rural diabetic population."

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