1358-P: Disparities in Acute and Chronic Complications of Diabetes in Rural U.S.

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Rural Americans are more likely than urban Americans to be diagnosed with diabetes, to have poorly controlled diabetes, and to die from diabetes-related complications; however, there is little published data about the rates of acute and chronic diabetes complications in rural as compared to urban areas. We examined the rates of acute and chronic diabetes complications across the spectrum of rurality among U.S. adults with diabetes using OptumLabs Data Warehouse, a de-identified dataset of commercially insured and Medicare Advantage beneficiaries: remote (population <2,500; N=75,077), town (population 2,500-50,000; N=409,152), and city (population >50,000; N=2,417,334). As compared to cities, small towns had greater incidence of severe hyperglycemia (HR=1.1; 95% CI: 1.06, 1.14), severe hypoglycemia (HR= 1.15; 95% CI: 1.12, 1.18), end-stage kidney disease (HR=1.06; 95% CI: 1.04, 1.08), heart failure (HR=1.08; 95% CI: 1.07, 1.1), myocardial infarction (HR=1.14; 95% CI: 1.12, 1.16), osteomyelitis (HR=1.06; 95% CI: 1.04, 1.08), and revascularization (HR=1.06; 1.05, 1.08). Compared to cities, remote areas had higher incidence of myocardial infarction (HR=1.09; 95% CI: 1.05, 1.13), osteomyelitis (HR=1.09; 95% CI: 1.04, 1.14), and revascularization (HR=1.05; 95% CI: 1.03, 1.07). Urban areas had lower incidence of stroke: (Remote: HR=0.93; 95% CI: 0.89, 0.96); (Town: HR=0.98; 95% CI: 0.96, 0.99). There were no significant differences between the groups in the development of atrial fibrillation, Charcot joint, retinopathy, or lower extremity ulcer. Overall, rural areas had greater incidence of diabetes complications (remote areas in 3 out of 12 complications and towns in 7 out of 12 complications); however, cities had decreased incidence of stroke. An important limitation of this study is that it measures treatment/diagnosis rates, necessitating health care utilization. We therefore likely underestimate the rate of complications in rural areas, where gaps in access to health care is widely recognized. Disclosure K.Steiger: None. J.Herrin: Consultant; Johnson & Johnson Medical Devices Companies. K.Swarna: None. R.G.Mccoy: Consultant; Emmi. Funding National Institute of Diabetes and Digestive and Kidney Diseases (K23DK114497)