Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Fall;28(4):364-71.
doi: 10.1111/j.1748-0361.2012.00410.x. Epub 2012 May 31.

Quality of diabetes mellitus care by rural primary care physicians

Stephen A Tonks  1 , Sohil Makwana, Amanda H Salanitro, Monika M Safford, Thomas K Houston, Jeroan J Allison, William Curry, Carlos A Estrada
Affiliations

Quality of diabetes mellitus care by rural primary care physicians

Stephen A Tonks et al. J Rural Health. 2012 Fall.

Abstract

Purpose: To explore the relationship between degree of rurality and glucose (hemoglobin A1c), blood pressure (BP), and lipid (LDL) control among patients with diabetes.

Methods: Descriptive study; 1,649 patients in 205 rural practices in the United States. Patients' residence ZIP codes defined degree of rurality (Rural-Urban Commuting Areas codes). Outcomes were measures of acceptable control (A1c < = 9%, BP < 140/90 mmHg, LDL < 130 mg/dL) and optimal control (A1c < 7%, BP < 130/80 mmHg, LDL < 100 mg/dL). Statistical significance was set at P < .008 (Bonferroni's correction).

Findings: Although the proportion of patients with reasonable A1c control worsened by increasing degree of rurality, the differences were not statistically significant (urban 90%, large rural 88%, small rural 85%, isolated rural 83%; P = .10); mean A1c values also increased by degree of rurality, although not statistically significant (urban 7.2 [SD 1.6], large rural 7.3 [SD 1.7], small rural 7.5 [SD 1.8], isolated rural 7.5 [SD 1.9]; P = .16). We observed no differences between degree of rural and reasonable BP or LDL control (P = .42, P = .23, respectively) or optimal A1c or BP control (P = .52, P = .65, respectively). Optimal and mean LDL values worsened as rurality increased (P = .08, P = .029, respectively).

Conclusions: In patients with diabetes who seek care in the rural Southern United States, we observed no relationship between degree of rurality of patients' residence and traditional measures of quality of care. Further examination of the trends and explanatory factors for relative worsening of metabolic control by increasing degree of rurality is warranted.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Proportions of patients with reasonable and optimal hemoglobin A1c, blood pressure (BP, mmHg), and low-density lipoprotein cholesterol (LDL, mg/dL) for patients with diabetes in Southeastern United States by Rural-Urban Commuting Areas (RUCA) categories (n = 1,649 patients) (all P > .05).
Figure 2
Figure 2
Mean hemoglobin A1c, systolic and diastolic blood pressure (SBP, DBP), and low-density lipoprotein cholesterol (LDL-C) for patients with diabetes in Southeastern United States by Rural-Urban Commuting Areas (RUCA) categories (n = 1,649 patients). Values are means and 95% confidence intervals.
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2007. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2008.
    1. Centers for Disease Control and Prevention. [Accessed December 22, 2011];Diabetes Public Health Resource. Available at: http://www.cdc.gov/diabetes/statistics/index.htm.
    1. Utz S. Diabetes care among rural Americans. Annu Rev Nurs Res. 2008;26:3–39. - PubMed
    1. Krishna S, Gillespie K, McBride T. Diabetes burden and access to preventive care in the rural United States. J Rural Health. 2010;26(1):3–11. - PubMed
    1. Andrus M, Kelley K, Murphey L, Herndon K. A comparison of diabetes care in rural and urban medical clinics in Alabama. J Community Health. 2004;29(1):29–44. - PubMed

Publication types