Diabetic patients living in rural areas are more likely to develop complications, study finds

It is well established that people living in rural areas of the United States are more likely to develop diabetes and experience obstacles in managing their condition than those living in suburban or urban areas. Masu. Now, researchers at the University of Maryland School of Medicine have measured the devastating toll of this health disparity.

People living in small towns have a significantly greater risk of experiencing eight diabetes-related complications, including heart attacks and kidney disease, than those living in populous suburbs or cities, according to a new study. It is said to be expensive. published in a diary diabetes care.

The study analyzed health insurance data for nearly 3 million adults with diabetes across the United States over a 10-year period ending in 2021. They found that people living in small towns (population size between 2,500 and 50,000) were 10 percent more likely to experience diabetes. Compared to people living in large cities, he is 5% more likely to have a heart attack and about 4% more likely to develop end-stage renal disease.

“People living in rural areas have a higher risk of experiencing eight of the 11 complications we measured than those living in cities,” said lead author of the study and associate professor of medicine at UMSOM. said Rosalina McCoy, MD, Director of Precision. Medicine and Population Health Program, University of Maryland Institute for Health Computing.

“They are 15% more likely to have dangerously low blood sugar levels, which is a clear sign that their diabetes is not properly controlled.”

About 14% of those surveyed lived in small towns, compared to 83% who lived in cities. An additional 3% lived in remote areas with fewer than 2,500 people living within a defined geographic area within the county.

“While our study did not address why these differences exist, people living outside of urban areas have less access to care from a diabetes specialist and less diabetes self-management education. study co-author, professor of family and community medicine and senior associate dean for population and community medicine at UMSOM. said Esa Davis, M.D., Ph.D.

“Our study builds on fundamental evidence to demonstrate the potential impact of these differences on preventable diabetes complications.”

Interestingly, the study found that people living in remote areas had a lower risk of being diagnosed with some diabetes complications. They were 15% less likely to have dangerously high blood sugar levels and 6% less likely to experience heart failure than people living in small towns.

But that may not actually mean fewer complications. The researchers relied on insurance information to identify complications of diabetes, so if people don't have access to medical care, those complications go undetected.

Dr. McCoy noted that this finding further highlights the barriers to care in remote areas. Patients are likely suffering from a hyperglycemic emergency or heart failure, but are unable to go to the emergency department or hospital for diagnosis and treatment.

Researchers controlled for age, gender, health insurance type, type of diabetes, drug use, and chronic health conditions.

Mark T. Gladwin, M.D., Ph.D., said, “Although the increased relative risk of diabetic complications was modest for people living in rural areas, more than 5 million Americans with diabetes live in small towns. Therefore, they can pose a significant health burden.” He is the John Z. and Akiko K. Bowers Distinguished Professor and Dean of UMSOM, and vice president for medical affairs at the University of Maryland, Baltimore.

“There is an urgent need to strengthen physician and health care provider services and hospital services for people living in rural areas, and we are moving medical students to Maryland's rural Eastern Shore to address this disparity. We are planning a new program to take you to.”