Rural Americans with type 1 diabetes face health disparities that can contribute to diabetes-related complications. This study sought to examine glycemic outcomes among rural participants in the Type 1 Diabetes (T1D) Exchange clinic registry between January 1, 2016 and March 31, 2018. Data were identified by rural status as defined by the Centers for Medicaid and Medicare, and stratified by age range, and eventually multivariate regression modeling was performed to isolate glycemic differences based on hemoglobin A1c (HbA1c) levels. A full multivariate regression model including all significant (p<0.05 via two-sided testing) differential factors was determined with an additional indicator for rural status. Finally, the multivariate model was reduced using backwards elimination stepwise procedures until only significant (p<0.05 via two-sided testing) factors were included. Mean HbA1c levels for all rural participants (n=1837) were significantly higher (mean 8.71% [SD 1.66%]) compared to the non-rural group (mean 8.48% [SD 1.63%]), p<0.001. Rural children under age 13 (n=224) had a significantly higher average HbA1c (8.65% [1.17%]) compared to the non-rural group (8.45% [1.19%]), p=0.022. Rural adolescents between ages 13-18 (n=609) had a significantly higher average HbA1c (9.39% [1.73%]) than the non-rural group (9.14% [1.69%]), p<0.001. Rural young adults between ages 18-26 had a higher average HbA1c (9.07% [1.77%]) than the non-rural group (8.88% [1.78%]), p=0.042. The average HbA1c among rural adults (n=589) over age 26 was not significantly different (7.72% [1.21%] than those of non-rural adults (7.76% [1.15%]), p=0.503. There is a clear pattern in glycemic outcome disparities even after adjustment for characteristic differences between rural and non-rural participants in the T1D Exchange, most strikingly among youth. The full extent of this disparity and the contributing factors need to be more thoroughly studied to provide effective solutions.
A.K. Gill: None. M.D. Gothard: None. K. Briggs Early: None.
