Adults in small towns face higher impact of diabetes complications: Study

A comprehensive study highlighted the significant disparities in the health outcomes of diabetes patients across the United States by focusing the impact of living in rural areas versus urban centers. The key findings of the study were published in the Diabetes Care journal.

This study utilized data from the OptumLabs Data Warehouse which included a deidentified dataset of U.S. commercial and Medicare Advantage beneficiaries to illuminate the relative dangers of diabetes complications along the rural-urban continuum. The retrospective cohort study followed a total of 2,901,563 adults who were diagnosed with diabetes from January 2012 to December 2021 to understand how geographic location affects the prevalence of both acute and chronic complications associated with the condition. This research by Kyle Steiger and team classified the areas into three categories based on population size; the cities (population over 50,000), small towns (population 2,500–50,000) and remote areas (population under 2,500).

The findings from the study indicate that residents of small towns are at a significantly higher risk of undergoing the wide range of diabetes complications when compared to their urban counterparts. The adjusted hazard ratios (HRs) for residents of small towns showed increased risks of hyperglycemia, hypoglycemia, end-stage kidney disease, myocardial infarction, heart failure, amputation, other lower-extremity complications and revascularization. Also, these individuals had a slightly reduced risk of stroke.

There was a marked higher risk of myocardial infarction and revascularization in the remote areas and the residents experienced lower risks of hyperglycemia and stroke when compared to city dwellers. Also, when comparing remote areas to small towns, the data suggested lower hazards for hyperglycemia, hypoglycemia and heart failure among the former. The study found no significant geographical variation in the risks of developing retinopathy and atrial fibrillation/flutter that suggests some complications of diabetes are uniformly distributed regardless of residential location.

The implications of these findings highlight a clear need for targeted healthcare policies and interventions that address the unique challenges underwent by diabetes patients living in small towns and remote areas. The outcomes behind the study call for further investigation into the underlying reasons for these geographic disparities, with the goal of developing more effective strategies to reduce the increased risks by these populations. Overall, this research underscores the importance of considering geographical context in the management and prevention of diabetes complications that urge healthcare providers and policymakers to adapt their approaches to the diverse needs of patients.

Source:

Steiger, K., Herrin, J., Swarna, K. S., Davis, E. M., & McCoy, R. G. (2024). Disparities in Acute and Chronic Complications of Diabetes Along the U.S. Rural-Urban Continuum. In Diabetes Care. American Diabetes Association. https://doi.org/10.2337/dc23-1552