Diabetes Complications More Common in Patients Not Living in Urban Areas

WEDNESDAY, March 27, 2024 (HealthDay News) -- Adults with diabetes living in small towns are disproportionately impacted by complications of diabetes, according to a study published online Feb. 22 in Diabetes Care.

Kyle Steiger, M.D., from the Mayo Clinic in Rochester, Minnesota, and colleagues used the OptumLabs Data Warehouse to identify 2.9 million U.S. commercially insured adults and Medicare Advantage beneficiaries with diabetes (January 2012 through December 2021) to compare the risk for diabetes complications in remote areas (population <2,500), small towns (population 2,500 to 50,000), and cities (population >50,000).

The researchers found that compared with residents of cities, residents of remote areas had greater hazards of myocardial infarction (hazard ratio [HR], 1.06) and revascularization (HR, 1.04). But residents of remote areas had a lower risk for hyperglycemia (HR, 0.90) and stroke (HR, 0.91). Residents of small towns had greater hazards of hyperglycemia (HR, 1.06), hypoglycemia (HR, 1.15), end-stage kidney disease (HR, 1.04), myocardial infarction (HR, 1.10), heart failure (HR, 1.05), amputation (HR, 1.05), other lower-extremity complications (HR, 1.02), and revascularization (HR, 1.05) compared with residents of cities, but they had a lower risk for stroke (HR, 0.95). Residents of remote areas versus those living in small towns had lower hazards of hyperglycemia (HR, 0.85), hypoglycemia (HR, 0.92), and heart failure (HR, 0.94). There was no geographic variation in the risk for retinopathy and atrial fibrillation/flutter.

"While our study didn’t address why these differences exist, we do know that people living outside of city areas are less likely to receive care from diabetes specialists, to receive diabetes self-management education, and to be monitored for diabetes complications," coauthor Esa Davis, M.D., from the University of Maryland in Baltimore, said in a statement. "Our research builds on this foundational evidence to demonstrate a possible impact that these differences have on preventable diabetes complications."

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