Rural‐urban differences in uptake of diabetes self‐management education among Medicare beneficiaries: Results from the 2016 to 2018 Medicare Current Beneficiary Survey

Abstract

To assess rural-urban differences in participation rates of diabetes selfmanagement education and associated factors among Medicare beneficiaries with type 2 diabetes (T2DM).Methods: Data were from the 2016 to 2018 Medicare Current Beneficiary Survey (MCBS). Participation in diabetes self-management education was self-reported. The study sample included 3,799 beneficiaries aged 65 years and older with self-reported T2DM. Logistic regression was used to assess the association of participation in diabetes self-management education and residential location. Sampling weights embedded in the MCBS were incorporated into all analyses.Findings: Overall, the participation rate of diabetes self-management education was 46.8% (95% CI: 44.4%-49.2%). The rate was 40.3% for beneficiaries in rural areas, 48.0% for suburban areas, and 47.3% for urban areas. About 31% of beneficiaries newly diagnosed with diabetes did not participate within the past year. Controlling for other covariates, beneficiaries in rural areas were less likely to have participated in diabetes self-management education (AOR = 0.73, 95% CI: 0.55-0.95) than those living in urban areas. Asian Americans were less likely to have participated (AOR = 0.49, 95% CI: 0.28-0.84) than Whites. Those who were older, with lower education, and lower income levels were less likely to have participated (P < .05). Conclusions:Recent MCBS data indicate that more than half of Medicare beneficiaries with T2DM did not participate in diabetes self-management education, and the participation rate in rural areas was 7 percentage points lower than that in urban areas. The study findings highlight challenges to maximize the benefits of participating in diabetes self-management education, particularly in rural areas.

Diabetes self-management education (DSME) for older persons in Western countries: A scoping review

“…Race and ethnicity data were poorly described or lacking in most studies [ 10 , 11 , 13 , 14 , 16 , 19 , 24 , 25 , 27 – 29 , 31 – 33 , 38 , 52 , 53 , 58 , 60 – 62 , 64 , 66 ]. In seven studies, the population was described primarily as “white” [ 22 , 35 , 36 , 54 , 55 , 58 ]; other terms used by researchers were “caucasian” [ 30 , 56 , 63 , 65 ], “English ethnicity” [ 20 ], “Western ethnicity” [ 24 ], and “British” [ 9 ]. In the remaining five studies, the population was primarily described as “Black” [ 12 , 37 , 57 ] and “Mexican American” [ 15 , 26 ].…”

“…Additionally, there is a need to include rural communities in the development of DSME programs. In this review, 10 studies included rural communities [ 9 , 11 , 13 , 20 , 33 , 35 , 36 , 58 , 65 , 66 ]. Luo et al [ 58 ] described how participation in diabetes education in rural settings was 7% lower than in urban areas.…”

“…In this review, 10 studies included rural communities [ 9 , 11 , 13 , 20 , 33 , 35 , 36 , 58 , 65 , 66 ]. Luo et al [ 58 ] described how participation in diabetes education in rural settings was 7% lower than in urban areas. Robertson et al [ 20 ] found rural living was described by participants as a barrier to successful diabetes management and education; the distance to access physical activity programs, groceries, diabetes education, and medical care was noted as a major concern.…”

“…Socioeconomic status—a SDH—was reported in 13 studies [ 11 , 13 , 15 , 18 – 20 , 28 , 35 , 53 , 54 , 58 , 59 , 65 ]. Older persons with diabetes living on a low income are often underrepresented in the development of DSME strategies [ 18 ].…”

Utilization of Diabetes Self-Management Program among Breast, Prostate, and Colorectal Cancer Survivors: Using 2006-2019 Texas Medicare Data

“…starting from 2016 to incentivize a longer time spent on CCM services [25]. As a result, DSMT providers might focus more on current users to maximize the amount of reimbursement instead of attracting new users.…”