Are Guideline Concordant Processes of Care Consistent Across the Rural-Urban Continuum? A Retrospective Cohort Study of Adults Newly Treated for Type 2 Diabetes
Abstract
OBJECTIVE
To explore the association between place of residence (metropolitan, urban, rural) and guideline concordant processes of care in the first year of type 2 diabetes management.
METHODS
We conducted a retrospective cohort study of new metformin users between April 2015 and March 2020 in Alberta. Outcomes were identified as guideline concordant processes of care through the review of clinical practice guidelines and published literature. Using multivariable logistic regression, the following outcomes were examined by place of residence: dispensation of a statin, angiotensin-converting-enzyme-inhibitor (ACEi) or angiotensin-II-receptor-blocker (ARB), eye examination, and glycated hemoglobin A1C, cholesterol, and kidney function testing.
RESULTS
Of 60,222 new metformin users, 67% resided in a metropolitan area, 10% in urban, and 23% in rural. After confounder adjustment, rural residents were less likely to have a statin dispensed (aOR0.83; 95%CI:0.79-0.87) or undergo cholesterol testing (aOR0.86; 95%CI:0.83-0.90), compared to metropolitan residents. In contrast, rural residents were more likely to receive A1C and kidney function testing (aOR1.14; 95%CI:1.08-1.21 and aOR1.17; 95%CI:1.11-1.24, respectively). ACEi/ARB use and eye examinations were similar across place of residence.
CONCLUSIONS
Processes of care varied by place of residence. Limited cholesterol management in rural areas is concerning because this may lead to increased cardiovascular outcomes.
Read the paper
Related studies
- Metformin as an adjuvant in breast cancer treatment
- Metformin Lysosomal Targeting: A Novel Aspect to Be Investigated for Metformin Repurposing in Neurodegenerative Diseases?
- Aberrant HSF1 signaling activation underlies metformin amelioration of myocardial infarction in mice
- Metformin induces ZFP36 by mTORC1 inhibition in cervical cancer-derived cell lines
- Protein Interaction Network for Identifying Vascular Response of Metformin (Oral Antidiabetic)
- Preventing Long COVID With Metformin
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.