Factors Associated with Glycemic Control in Patients with Type 2 Diabetes Mellitus in Rural Areas of the United States

Abstract

Background: According to the US Department of Health and Human Services, an estimated 18.2 million Americans, or 6.3% of the population, has diabetes mellitus (DM). Approximately 90% of these individuals have type 2 DM. The most widely used clinical test for defining glycemic control is measurement of blood glycosylated hemoglobin (AIC). Objective: The goal of this study was to estimate the proportion of diabetic patients who achieved the AIC goal of _<7.0% in a rural western Pennsylvania practice and to determine the factors that influence the achievement of the AIC goal. Methods: This was an observational study conducted in a rural family medicine office in Clarksburg, Pennsylvania. To be included in the study, patients had to have been diagnosed with type 2 DM >2 years prior, had to be aged >18 years, and had to be adhering to a medical nutrition therapy diet. Both univariate analysis and logistic regressions were used to identify the factors that were associated with the outcome. Results: A total of 136 diabetic patients were included in the study (70 men, 66 women; mean [SD] age, 59.7 [15.2] years). AIC of <7.0% was attained in 75.0% (n = 102) of the patients. Although the majority of patients were obese (69.1% [n = 94] with a body mass index >30 kg/m2), weight was not a factor in reaching AIC goal. The data showed that those patients who were older (62.3 vs 51.9 years; P = 0.004), using oral antidiabetic medication (96.1% vs 87.9%; P = 0.100), and not using insulin (86.3% vs 69.7%; P = 0.030) were more likely to achieve AIC goal. The proportion of patients achieving AIC goal levels decreased as the number of oral medications used increased. Conclusions: In this rural area of western Pennsylvania, the majority of our type 2 DM patients achieved glycemic control (ie, AIC <7.0%). The primary care physician, along with a DM care team, should address the issues of diet, exercise, weight management, and other comorbid illnesses to properly manage patients with type 2 DM. (Insulin. 2007;2:134-141)