Burden and management of type 2 diabetes in rural United States

Abstract

In the United States, rural areas have a higher burden of type 2 diabetes (T2DM) compared to urban areas. However, there is limited information on risk factors and interventions that improve the primary prevention and management of T2DM in rural areas. To synthesize current knowledge on T2DM in rural areas and to guide healthcare providers and policy makers, we reviewed five scientific databases and the grey literature over the last decade (2010–2020). We described classification systems for rurality and the T2DM burden based on rurality and region (West, South, Midwest, and Northeast). We highlighted risk factors for T2DM in rural compared to urban areas, and summarized interventions to screen and manage T2DM based on opportunistic screening, T2DM self‐management, community‐based initiatives, as well as interventions targeting comorbidities and T2DM. Several studies identified the co‐existence of T2DM and depression/psychological symptoms, which could reduce adherence to non‐pharmacologic and pharmacologic management of T2DM. We highlighted the role of technology in education and counselling of patients with geographic and financial barriers to accessing care, which is exacerbated by the SARS‐CoV‐2 coronavirus disease‐19 pandemic. We identified knowledge gaps and next steps in improving T2DM care in rural areas. There is an urgent need for interventions tailored to rural areas given that rural Americans currently experience a disproportionate burden of T2DM and are encumbered by its associated morbidity, mortality, and loss in economic productivity.

Association Between Globulin and Diabetic Nephropathy in Type2 Diabetes Mellitus Patients: A Cross-Sectional Study

“…Diabetes is one of the most common chronic diseases confering about a two-fold excess risk for coronary heart disease, major stroke subtypes, and deaths attributed to other vascular causes ( 23 ). And patients tend to have pathological changes in other organs during a period of time ( 24 ), which will bring a lot of psychological and economic burden to patients and reduce their life experience ( 25 ). Therefore, a full understanding of the risk factors for these lesions can reduce the risk of diabetic complications and improve the well-being of patients.…”

Association of Cardiovascular Disease Risk Factors With Sociodemographic Characteristics and Health Beliefs Among a Community-Based Sample of African American Adults in Minnesota

“…This would not explain the higher prevalence of CVD risk factors we observed because rural-dwelling adults consistently experience worse CV health and increased CVD risk factors compared with urban adults independent of race. [21][22][23][24] The Jackson Heart Study (JHS) is a contemporary, prospective, community-based cohort of AA adults designed to investigate CVD risk factors. 25 We again observed higher prevalence of CVD risk factors in our participants compared with the JHS, including current smoking (25% vs 13%), hyperlipidemia (47% vs 33%), and diabetes (34% vs 19%).…”

Comparison of Body Mass Index and Waist Circumference in the Prediction of Diabetes: A Retrospective Longitudinal Study

“…Compared to urban areas, rural areas have disadvantages in maintenance and risk assessment of obesity as an important risk factor of [52,53]. Dual-energy X-ray absorptiometry, computed tomography, and magnetic resonance imaging can offer imaging information on subcutaneous or abdominal fat tissue compartments or adipose tissue in muscle to predict diabetes risk more accurately than anthropometric measurements [9,51,54], however, they are not routinely recommended due to the limited availability, exposure to radiation, and cost.…”