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J Diabetes Complications. 2011 Nov-Dec;25(6):387-92. doi: 10.1016/j.jdiacomp.2011.08.003. Epub 2011 Oct 7.

Disparities in diabetes self-management and quality of care in rural versus urban veterans.

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Center for Disease Prevention and Health Interventions for Diverse Populations, Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC 29425-0593, USA.



There are distinct geographic differences in diabetes-related morbidity and mortality; however, data regarding self-management and clinical outcomes are limited. This study examined diabetes care among veterans residing in rural versus urban areas.


A national data set was analyzed based on 10,570 veterans with type 2 diabetes. Residence was determined according to US census-based metropolitan statistical area. Primary outcomes were self-management behaviors (lifestyle and self-monitoring) and quality of care indicators (provider visits, laboratory monitoring and preventive measures). Multivariate analyses were done using STATA v10 to assess the independent effect of veteran residence on each outcome measure and to account for the complex survey design.


Among veterans with diabetes, 21.4% were rural residents. Compared to urban veterans, rural veterans had significantly lower education, less annual income and less received diabetes education (P = .002). The final regression model showed that daily foot self-check was the only self-management behavior significantly higher among rural veterans (odds ratio 1.36, 95% confidence interval 1.10-1.70). Provider-based quality of care was not significantly different between groups.


Diabetes self-foot care was significantly better among rural veterans than their urban counterparts, but quality of care was equivalent. This suggests that clinical diabetes care among veterans is uniform; however, greater efforts for patient education and support in diabetes self-management are needed to improve outcomes.

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