Center for Disease Prevention and Health Interventions for Diverse Populations, Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC 29425-0593, USA.
J Diabetes Complications. 2011 Nov-Dec;25(6):387-92. doi: 10.1016/j.jdiacomp.2011.08.003. Epub 2011 Oct 7.
There are distinct geographic differences in diabetes-related morbidity and mortality; however, data regarding self-management and clinical outcomes are limited. This study examined diabetes care among veterans residing in rural versus urban areas.
A national data set was analyzed based on 10,570 veterans with type 2 diabetes. Residence was determined according to US census-based metropolitan statistical area. Primary outcomes were self-management behaviors (lifestyle and self-monitoring) and quality of care indicators (provider visits, laboratory monitoring and preventive measures). Multivariate analyses were done using STATA v10 to assess the independent effect of veteran residence on each outcome measure and to account for the complex survey design.
Among veterans with diabetes, 21.4% were rural residents. Compared to urban veterans, rural veterans had significantly lower education, less annual income and less received diabetes education (P = .002). The final regression model showed that daily foot self-check was the only self-management behavior significantly higher among rural veterans (odds ratio 1.36, 95% confidence interval 1.10-1.70). Provider-based quality of care was not significantly different between groups.
Diabetes self-foot care was significantly better among rural veterans than their urban counterparts, but quality of care was equivalent. This suggests that clinical diabetes care among veterans is uniform; however, greater efforts for patient education and support in diabetes self-management are needed to improve outcomes.
糖尿病相关发病率和死亡率存在明显的地域差异；然而，有关自我管理和临床结果的数据有限。本研究调查了居住在农村和城市地区的退伍军人的糖尿病护理情况。
根据 10570 名 2 型糖尿病退伍军人的全国性数据进行分析。根据美国人口普查的大都市区统计区确定居住地点。主要结果是自我管理行为（生活方式和自我监测）和护理质量指标（就诊次数、实验室监测和预防措施）。使用 STATA v10 进行多变量分析，以评估退伍军人居住地点对每个结果衡量指标的独立影响，并考虑到复杂的调查设计。
在患有糖尿病的退伍军人中，21.4%是农村居民。与城市退伍军人相比，农村退伍军人的教育程度较低，年收入较少，接受糖尿病教育的比例也较低（P=0.002）。最终的回归模型显示，农村退伍军人每天进行足部自我检查的自我管理行为明显更高（比值比 1.36，95%置信区间 1.10-1.70）。基于提供者的护理质量在两组之间没有显著差异。
与城市退伍军人相比，农村退伍军人的糖尿病自我足部护理明显更好，但护理质量相当。这表明退伍军人的临床糖尿病护理是统一的；然而，需要进一步努力为糖尿病自我管理患者提供教育和支持，以改善结果。
