Diabetes More Prevalent In Rural Population

Dr. Carlos Aguero, family medicine specialist at the college of medicine’s Rockton clinic, said the college took on the project because of its strong emphasis on rural health.

“One of the interesting things was that we did not find any previous studies that were looking at this information,” Aguero said. “We looked for local studies and studies that had been done for the entire U.S. population and, really, there was zero data on differences between the two.”

The study used a sample of 37,133 adult diabetes patients identified in Behavioral Risk Factor Surveillance Surveys compiled by the U.S. Centers for Disease Control and all 50 states.

Aguero said the study showed that 9.7 percent of the adults living in rural areas, identified as being outside metropolitan or suburban areas, had diabetes and 8.2 percent in the metropolitan and suburban areas had diabetes “meaning, if you were living in a rural area, you were 16 percent more likely to have diabetes.”

He said researchers thought the opposite might have been true based on the idea that “you would think that, living in a rural area, maybe you were eating better, healthier foods and maybe being more physically active as opposed to people living in the city who you might think would be getting more fatty foods, being very sedentary and using their car to go to everywhere.”

Aguero also said that, based on the five standards of appropriate care established by the American Diabetes Association, rural residents were also 20.5 percent more likely than urban dwellers not to be receiving such care.

The five standards are receiving a score of 7 or higher on a hemoglobin A1C test, having had a cholesterol check within the past 12 months; had they had their feet examined by a doctor in the past 12 months; did they receive a dilated eye exam at least once a year; and whether they have ever been referred for diabetes education.

“If you’re going to take really good care of somebody with diabetes,” Aguero said, “you’ve got to make that you’re checking their feet because one of the things that happens in diabetes is that people get poor circulation and poor sensation on their feet. They’re likely, for instance, to have a little callous or something that becomes infected and, because they don’t have good circulation, that infection could eventually end in an amputation which ultimately not only reduces the quality of life but also the life expectancy of someone with diabetes.”

He said the dilated eye exam, because diabetes causes changes in the retinas that could lead to sight loss, and hemoglobin A1C tests should be done annually for someone who has been diagnosed with diabetes.

The college of medicine study wasn’t designed to find the reasons for the disparities, Aguero said, “so we can only speculate, but it points toward an area that definitely needs to be looked into.”

The information was included in a report looking into disparities in diabetes care, one of five presentations by college of medicine personnel at last month’s North American Primary Care Research Group annual meeting in Puerto Rico, Nov. 2008.