In a new nationwide study, Mayo Clinic researchers have shed light on factors contributing to diabetes rates in rural America. Their observational study found people in rural areas were more likely to develop diabetes (higher incidence) and to already have it (greater prevalence) compared to people in urban areas. However, when risk factors that can be changed, such as inactivity and obesity, were accounted for, the gap in diabetes prevalence and incidence narrowed, and in some cases, the trend reversed. Higher levels of inactivity and obesity were the strongest predictors of higher diabetes rates.

These findings suggest that rural Americans can make a big difference in their risk for diabetes with the right resources, including targeted medical and lifestyle interventions promoting healthy behaviors. In addition, these interventions could improve diabetes prevention for all people, no matter where they live.

Sagar Dugani, M.D., Ph.D., the study's first author, says that future research will focus on the best strategies for addressing diabetes risks in rural populations.

When the researchers analyzed diabetes rates in different regions of the country, they found different associations between how rural a community was and its diabetes incidence rates. These findings suggest that tailored approaches may be needed to meet the diverse needs of rural communities and reduce diabetes-related disparities.

Adrian Vella, M.D., the study's senior author, says the study also emphasizes that taking care of diabetes involves more than just medication.

"Diabetes care also requires a suitable care environment and infrastructure," says Dr. Vella. 

Diabetes is a chronic health condition that requires lifelong care. It is also the costliest chronic condition in the U.S., expected to affect 1 in 3 Americans in their lifetime. In the U.S., 15% of the population lives in rural areas and experiences a wide range of health disparities.

The researchers say that, to their knowledge, this study is the most comprehensive report on the relationship between rurality and the incidence and prevalence of diabetes in the U.S. The study used U.S. Centers for Disease Control and Prevention (CDC) data from 2004 through 2019 to generate estimates of the incidence and prevalence of diabetes across the U.S. in 3,148 counties.  This investigation is part of a growing body of Mayo Clinic research, including this study on diabetes-related deaths, focused on understanding and finding solutions for rural health disparities.

Past studies have shown that interventions designed to promote physical exercise and improve access to healthy food helped to prevent diabetes, the researchers note.

"We plan to engage people, communities, researchers and policymakers to design comprehensive strategies for diabetes care," says Dr. Dugani.

Dr. Dugani is an academic hospitalist at Mayo Clinic and associate director of the Community-Engaged Research Program in the Mayo Clinic Center for Clinical and Translational Science.

Dr. Vella is the Earl and Annette R. McDonough Professor of Medicine in the Division of Endocrinology, Diabetes, Metabolism and Nutrition.

Review the study for a complete list of authors, disclosures and funding.

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