Quality of Diabetes Mellitus Care by Rural Primary Care Physicians

The Journal of Rural Health, 06/15/2012

Tonks SA et al. – In patients with diabetes who seek care in the rural Southern United States, they observed no relationship between degree of rurality of patients’ residence and traditional measures of quality of care. Further examination of the trends and explanatory factors for relative worsening of metabolic control by increasing degree of rurality is warranted.


  • Descriptive study; 1,649 patients in 205 rural practices in the United States.
  • Patients’ residence ZIP codes defined degree of rurality (Rural-Urban Commuting Areas codes).
  • Outcomes were measures of acceptable control and optimal control.
  • Statistical significance was set at P < .008 (Bonferroni's correction).


  • Although the proportion of patients with reasonable A1c control worsened by increasing degree of rurality, the differences were not statistically significant (urban 90%, large rural 88%, small rural 85%, isolated rural 83%; P= .10); mean A1c values also increased by degree of rurality, although not statistically significant (urban 7.2 [SD 1.6], large rural 7.3 [SD 1.7], small rural 7.5 [SD 1.8], isolated rural 7.5 [SD 1.9]; P= .16).
  • Optimal and mean LDL values worsened as rurality increased (P= .08, P= .029, respectively).

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