Updating Rural–Urban Disparities in Diabetes Self Management Training Utilization Among Fee for Service Medicare Beneficiaries, 2017–2023

Diabetes Self Management Training (DSMT) is a covered Medicare benefit shown to improve clinical outcomes and reduce avoidable utilization among beneficiaries with diabetes. In 2020, the Rural and Underserved Health Research Center conducted a national analysis of rural–urban disparities in DSMT utilization among fee-for-service (FFS) Medicare beneficiaries using 2016 data. That study identified pronounced geographic disparities, with DSMT services concentrated in urban counties and limited availability across rural areas, despite comparable diabetes prevalence.

Since the release of the original report, multiple additional years of Medicare data have become available. This project proposes to replicate and update the 2020 analysis using 2017–2023 data to assess longitudinal trends in DSMT utilization, evaluate whether access gaps persist, and provide updated evidence to inform HRSA, policymakers, and rural health stakeholders. The updated analysis will maintain methodological consistency with the original study to enable direct comparison over time.