Stephanie Rutledge|Svetlana Masalovich|Rachel Blacher|Magon M. Saunders
Diabetes Self-Management Education Programs in Nonmetropolitan Counties — United States, 2016
National Center for Chronic Disease Prevention and Health Promotion|Northrop Grumman (United States)|National Center for Chronic Disease Prevention and Health Promotion|National Center for Chronic Disease Prevention and Health Promotion
diabetes selfmanagement education dsme clinical practice intended improve preventive practices behaviors focus decisionmaking problemsolving selfcare distribution correlates established dsme programs nonmetropolitan counties across united states previously described characteristics nonmetropolitan counties dsme programsjuly 2016dsme programs recognized american diabetes association accredited american association diabetes educators ie active programs july 2016 shared cdc organizations us census bureaus census geocoder used identify county dsme program site using documented addresses county characteristic data originated us census bureau compiled us department agricultures economic research service 2013 atlas rural smalltown america data set county levels diagnosed diabetes prevalence incidence well number persons diagnosed diabetes previously estimated cdc report defined nonmetropolitan counties using ruralurban continuum code 2013 atlas rural smalltown america data set code included six nonmetropolitan categories 1976 urban rural counties 62 counties adjacent nonadjacent metropolitan countiesin 2016 total 1065 dsme programs located 38 1976 nonmetropolitan counties 62 nonmetropolitan counties dsme program total number dsme programs nonmetropolitan counties least one dsme program ranged 1 8 average 14 programs adjusting countylevel characteristics odds nonmetropolitan county least one dsme program increased percentage insured increased adjusted odds ratio aor 110 95 confidence interval ci 108113 percentage high school education less decreased aor 106 95 ci 104107 unemployment rate decreased aor 119 95 ci 111123 natural logarithm number persons diabetes increased aor 363 95 ci 315419in 2016 dmse programs nonmetropolitan socially disadvantaged counties united states number persons diabetes percentage insured percentage high school education less percentage unemployed significantly associated whether dsme program located nonmetropolitan countymonitoring distribution dsme programs county level provides insight needed strategically address rural disparities diabetes care outcomes findings provide information needed assess lack availability dsme programs explore evidencebased strategies innovative technologies deliver dsme programs underserved rural communities