Exploring the Intersection of Rural Health and Diabetes

This November marks two important health observances: National Diabetes Month, to recognize Americans living with diabetes and the individual, community, and national efforts to prevent and manage it, and National Rural Health Day (November 21), to honor the healthcare providers (HCPs), communities, organizations, and others dedicated to addressing the unique healthcare needs of rural America. These health observances may appear unrelated but share many intersection points when critically examined, shedding light on how diabetes affects rural Americans, the unique challenges they face in accessing care, and the programs put in place to help address this disparity in health.

Diabetes in Rural America

More than 38 million people are living with diabetes in the United States,¹ the majority (90%−95%) of whom have Type 2 diabetes (T2D),² but rural Americans are disproportionately affected. Compared to urban populations, Americans living in rural areas have a higher prevalence of T2D and increased risk for complications from diabetes, including heart attack.^3,4 Additionally, the diabetes mortality gap between urban and rural areas has significantly widened over time, tripling between 1999–2019.⁵

Rural communities face several barriers to healthcare access that compound their risk for chronic diseases like diabetes, including, but not limited to, lower median household income, higher rates of uninsurance, and HCP shortages.⁶ In fact, more than 63% of the primary care Health Professional Shortage Area (HPSA) designations are located in rural areas.⁷ The National Health Service Corps implemented a program to combat this workforce shortage by providing scholarships and loan repayment support for medical students in exchange for their service in an HPSA.

Spotlighting Efforts to Address Diabetes and Rural Health

When it comes to connecting rural Americans to diabetes management support, several national and community-level programs are available that providers in these areas can use.

National Efforts

The Centers for Disease Control and Prevention (CDC) provides diabetes self-management education and support (DSMES), connecting patients with a diabetes care and education specialist to offer personalized education on key self-care behaviors and skills to manage their diabetes. This comprehensive toolkit provides an overview with considerations for successfully delivering DSMES services. Though most (62%) rural areas don't have DSMES programs,⁸ the CDC has outlined opportunities to help people in these areas to access them, including offering them via telehealth or implementing a DSMES program in community-based settings instead of traditional healthcare facilities.

The CDC also operates the National Diabetes Prevention Program to help adults at risk for T2D prevent its onset through lifestyle changes (e.g., long-term dietary change, increased physical activity, weight loss strategies). To expand access to this program, the Centers for Medicare & Medicaid Services adapted the program for Medicare beneficiaries, the Medicare Diabetes Prevention Program (MDPP). The MDPP may be especially beneficial for rural Americans, 30% of whom are enrolled in Medicare.⁹ Learn more about the MDPP and specific Medicare beneficiary eligibility requirements.

JBS Project Spotlights

Increasing Awareness of MDPP

JBS conducted a Medicare claims data analyses and determined that awareness of and referrals to MDPPs were low among providers in Kentucky and Ohio. To combat this, we developed myriad educational materials, including videos, flyers, online modules, social media advertisements, and an email campaign to promote provider referrals to MDPP.

Promoting National Diabetes Month

JBS supports the National Institute of Diabetes and Digestive and Kidney Diseases’ (NIDDK) communications efforts for National Diabetes Month each November, including coordinating a radio media tour with NIDDK Director Dr. Griffin Rodgers. This year’s tour, themed “Take Charge of Tomorrow,” includes outreach efforts to rural populations through TV and radio news networks (e.g., Statewide Ohio, Statewide Kentucky, Mississippi and Tennessee Public News, NBC News Radio).

State-and-Community-level Efforts

State-and community-level and other local programs are also continuously being implemented throughout rural America to help citizens prevent, reduce risk factors for, and manage T2D. The bullets below list examples of such programs and the services they offer their communities:

• Vivir Mejor! (Live Better!) System of Diabetes Prevention and Care: An Arizona-based education program implemented to address high rates of diabetes in rural Hispanic/Latino populations near the U.S.-Mexico border
• Trinity Hospital Twin City's Fit for Life: An Ohio-based program dedicated to teaching adults how to achieve realistic lifestyle changes through fitness, health education, and personalized nutrition and fitness plans, with the goal of weight loss and chronic disease control
• The Adolescent Pre-Diabetes Prevention Program: A Louisiana-based education program focused on teaching adolescents with prediabetes how to adopt healthy lifestyles

Observing both National Diabetes Month and National Rural Health Day allows us to:

• Highlight national and community-level efforts to address diabetes in rural America and to honor the health professionals who support them
• Promote diabetes prevention and management in rural communities
• Recognize the health disparities and inequities that rural America faces

These health observances also bring to attention the need for more education and awareness building of diabetes, as well as expanded healthcare access, to ensure all people have the equal chance to live full, healthy lives.

References