Dialysis More Available Than Patient Education in Counties With High Diabetes Prevalence

Abstract

Introduction: Poorly controlled diabetes is a principal cause of end stage renal disease (ESRD), generating an estimated 44% of new cases. Diabetes self-management education and support (DSMES) has been documented to reduce adverse outcomes such as ESRD. Helping patients better manage their condition could ultimately reduce ESRD prevalence.

Methods: We compared the county-level availability of DSMES and dialysis as of November 2022 sorted by the estimated prevalence of diabetes among residents aged 18 years or older. The locations of DSMES programs and ESRD dialysis facilities were obtained from 2 professional organizations and the Centers for Medicare & Medicade Services. Estimated diabetes prevalence was obtained from the Centers for Disease Control and Prevention's PLACES data set. Counties were considered to have high diabetes prevalence if they fell into the top quartile for diabetes prevalence in 2019 (≥14.4% of adults). Analyses were conducted in 2023.

Results: DSMES was available in 41.0% of counties but in only 20.7% of counties with high diabetes prevalence versus 47.9% of low prevalence counties. Dialysis facilities were present in 59.2% of all counties, in 52.8% of all high diabetes prevalence counties, and in 61.4% of other counties. DSMES availability was linked to the presence of a hospital in the county, with only 6.3% of counties without a hospital offering the service.

Implications: DSMES could play a role in reducing the prevalence of ESRD. Public health professionals need to be aware of the differing levels of local availability of this service and work to develop partnerships to provide DSMES in high-prevalence areas not currently served.

Figure 1

Availability of diabetes self-management education and support (DSMES) and county (N = 3,141) diabetes prevalence (top quartile [≥14.4%] versus all lower quartiles [≤14.3%], 2019 estimates) (21). The PLACES data set does not include information for 2 county equivalents in Alaska, the Chugach Census Area and the Copper River Census Area. Source: Centers for Disease Control and Prevention. PLACES: Local Data for Better Health (21).

Figure 2

Dialysis availability and county diabetes prevalence (top quartile [≥14.4%] versus all lower quartiles [≤14.3%]), 2019 estimates) (21). DSMES, either alone or with dialysis, was available in 417 (52.8%) counties. The PLACES data set does not include information for 2 county equivalents in Alaska, the Chugach Census Area and the Copper River Census Area. Source: Centers for Disease Control and Prevention. PLACES: Local Data for Better Health (21).