By Tim Marema

Daily Yonder

The life expectancy of Americans with diabetes is diverging based on geography, with metropolitan areas seeing improvement in mortality rates while rural areas do not.

The result is that “rural America is being left behind” in efforts to reduce deaths caused by diabetes, the study says.

“As recently as 1999, rates for diabetes mortality were very similar for urban and rural areas,” says the article published in the Journal of Rural Health. “Over time, however, the gains in urban areas have not diffused to rural areas.”

That means the rural-urban gap in diabetes-related mortality is increasing.

“Rural America in general, and the rural South in particular, has seen little improvement in its diabetes mortality rate over the past two decades,” according to the report.

From 1999 to 2016, diabetes mortality rates improved by 5.1 points in the central counties of metros larger than 1 million residents. In “non-core” counties – the most “rural” category in the study – the mortality rate improved by only 0.85 points during the same period.

The study used national data to capture the cause of all deaths from 1999 to 2016. Researchers studied geographical differences by grouping counties into the National Center for Health Statistics system, which has six categories. The system divides metropolitan counties into four types and nonmetropolitan counties into two types (see definition below).

The counties that improved the most were those on the fringe of the largest metropolitan areas.

The decline in diabetes mortality was not related to a reduction in the number of people who have the disease. “More analysis is needed to understand what has driven the decline in diabetes mortality in many areas even as diabetes prevalence remains high,” the study says.

Possible causes are advancements in diabetes treatment or education, which may have been adopted at different rates in different regions. The study also said future research should look at the possible roles played by the Affordable Care Act or Medicare Part D, the prescription drug benefit that went into effect in 2006.

People with diabetes have abnormal levels of sugar or glucose in their bloodstream. High glucose levels result in a variety of complications, including cardiovascular and kidney disease. Ninety-five percent of diabetics have type 2 diabetes, in which the pancreas produces insufficient insulin or the body becomes resistant to insulin. Diet, exercise, and oral medication can frequently control the type 2 diabetes, especially in early stages. People with type 1 diabetes produce no insulin and must substitute manufactured insulin to regulate their blood glucose.

Citation: “The Changing Landscape of Diabetes Mortality in the United States Across Region and Rurality, 1999‐2016.” The Journal of Rural Health. February 2019. Timothy Callaghan, PhD; Alva O. Ferdinand, DrPH, JD; Marvellous A. Akinlotan, MPH, BDS; Samuel D. Towne Jr., PhD; Jane Bolin RN, JD, PhD.  https://onlinelibrary.wiley.com/doi/abs/10.1111/jrh.12354