1430-P: Demographic and Socioeconomic Predictors of Poor Glycemic Control among Rural Americans without a Prior Diagnosis of Diabetes

Introduction & Objective: Rural residents experience higher diabetes rates than their urban counterparts, which may be due to poverty or living in food deserts far from grocery stores. This study sought to identify risk factors for poor glycemic control among rural residents without a prior diagnosis of diabetes using data from a detailed health survey and food frequency questionnaire (FFQ).

Methods: We performed HbA1c testing among residents of Sullivan County, New York, a rural region known to have poor health outcomes and socioeconomic instability. We collected data on demographics, socioeconomic factors (income, education, unemployment, financial, food, and housing insecurity), disability, grocery accessibility (travel time to store), packaged food consumption (frequency of eating canned or plastic wrapped foods), and diet quality (based on healthy eating index scores) as possible predictors of poor glycemic control.

Results: Among 232 rural residents without a prior history of diabetes, 3 (1.3%) were found to have HbA1c ≥ 6.5%, consistent with previously undiagnosed diabetes, and 52 (22.4%) were in a prediabetes range (HbA1c: 5.7% to 6.4%). In the multivariable linear regression, statistically significant predictors of poor glycemic control among these rural residents included age (p<0.01), male sex (p=0.03), Black race (p<0.01), and food insecurity (p<0.01).

Conclusion: In our geographically-focused analysis of risk factors for rural diabetes, we did not find that diet quality or distance to grocery store were significant risk factors for poor glycemic control. Among the socioeconomic indicators tested, food insecurity was the only statistically significant risk factor for diabetes identified. Our results highlight the need to investigate how food insecurity increases diabetes risk among rural Americans especially if not mediated by poor diet quality, but through some other mechanism.