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[Medscape] Diabetes care often fails in rural areas, minority patients


Like real estate, the quality of diabetes care depends on “location, location, location,” a large cohort study led by a team from the Mayo Clinic, Rochester, Minnesota, found.

Adults with diabetes living in rural areas, as well as those living in socioeconomically disadvantaged areas, are much less likely to obtain optimal diabetes care than those living in rural areas. in urban areas and in less disadvantaged socio-economic areas. The results are even worse among racial and ethnic groups, the researchers found, December 29 on JAMA Network Open.

“The high cost of diabetes medications is high,” said Rozalina G. McCoy, Associate Professor of Medicine in the Mayo Clinic’s Division of Community Internal Medicine, Geriatrics, and Palliative Care and principal investigator of the study. diabetes, testing supplies and appointments, as well as difficulty in getting the medical care they need for their diabetes, all contribute to the gap in quality of care. diabetes in people in deprived areas”. “As clinicians and health systems, we need to better understand the challenges our patients face every day and work with them to help them overcome them.”

‘We’ll never get this diabetic animal under control if we just throw drugs at it.’

Alan Reisinger III, MD, associate medical director of MDVIP, a physician network operator that provides personalized primary care and preventive care based in Boca Raton, Florida, calls the study. This new study is “doing well and necessary”.

Reisinger, who is leading the effort to teach doctors how to prevent diabetes, stroke and heart attack, added that more patient education is needed starting at the primary level to prevent diabetes. .

“We would never get this diabetic animal under control if we just threw drugs at it,” Reisinger told Medscape Medical News. “In typical primary care practice, where you have 8 to 10 minutes to spend with the patient, there is simply not the time to spend on the most effective type of health training for managing a patient with diabetes or pre-diabetes”.

The study examined the medical records of 31,934 patients with diabetes aged 18 to 75 years receiving care at 75 primary care facilities across Minnesota, Iowa and Wisconsin.

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McCoy and her colleagues used data from the U.S. Census American Census to calculate regional deprivation levels (ADI) for U.S. Census block groups. where the patient lives and their zip code to determine if the area is rural or urban. The ADI is a measure of socioeconomic deprivation that reflects the income, employment, housing, and education levels of people living in a particular geographic area.

To assess the quality of care in rural and urban areas, as well as different levels of socioeconomic deprivation, the researchers used “D5” – a composite measure for comprehensive treatment of the disease. diabetes. Achieving D5 requires the patient to have control of blood sugar, blood pressure and lipids; take aspirin if they have ischemic heart disease; and do not use tobacco.

The researchers reported that 41% of patients (n = 13,138) achieved optimal D5 levels. They tend to be older, female, white, and live in more urban areas with relatively comfortable economic conditions. However, Dr. Shaheen Kurani, co-author, said, “We found that patients living in more rural and deprived areas were less likely to receive high-quality diabetes care than they were. with patients living in urban and less deprived areas”.

Among the results:

  • Patients living in rural areas were 16% less likely to meet the composite D5 index than patients in urban areas, while patients living in rural areas were more likely to achieve all All components of the D5 coefficient are lower than 19%. Patients from these highly rural and rural areas are also less likely to achieve lipid control than those living in urban areas. Tobacco use and blood pressure control were not related to rural residence.
  • Patients living in the 20 percent most deprived quintile of the census were 28% less likely to respond to the composite D5 index than patients living in the most deprived quintile. Residents in more deprived areas are also less likely to have glycemic control and not use tobacco.
  • Minority patients with diabetes were less likely to achieve glycemic, lipid, and blood pressure control goals than Caucasians.
  • Older patients were more likely to achieve D5 composite, glycemic control, lipid control, and tobacco-free. Men were less likely to achieve the D5 composite and individual components, with the exception of lipid control, regardless of gender.
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Telemedicine has the potential to help these patients, McCoy said, but not for patients who don’t have access to broadband internet service, “it’s often a barrier in rural areas that are high and don’t have access to broadband,” McCoy said. established medical care”.

She also emphasizes the importance of identifying and addressing barriers to diabetes care that face people living in socioeconomically deprived areas. The results provide “a framework for assessing the quality of diabetes care and equity through the lens of geographic disparity, providing rapidly actionable information for health systems.” , policymakers and payers to drive innovation and improvement in underserved areas,” she added.

One reviewer said Mayo’s study may not come as a surprise to primary care physicians in underserved areas of the country.

Alan Blum, MD, director of the Center for Tobacco and Social Research, Department of Family Medicine at the University of Alabama School of Medicine, Tuscaloosa, adds that most rural primary care physicians already understand know about the problems Mayo research solves. “With large amounts of data on rural and urban health disparities.”

“In my experience, rural GPs know their patients better, if not better than their urban counterparts,” he said. “They live in the same town as their patients, where they frequently collide with them outside of the healthcare facility.”

McCoy reported funding from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), which supported the research, as well as advised Emmi on the development of patient education materials. on prediabetes and diabetes. Other sources in the story said there was no financial conflict of interest involved.

Howard Wolinsky is a medical writer in Chicago, Illinois.

For more family medicine, diabetes and endocrinology news, follow Medscape on Facebook, Twitter, Instagram and YouTube.

Source: Medscape “Diabetes Care Often Fails Rural, Minority Patients”

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Translated by: Danh Cuong

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