This project will examine the degree to which counties with a high need for diabetes education, defined by high diabetes prevalence, have such education available. Findings will be linked to a related study that will examine the availability of dialysis for end stage renal disease, a severe outcome of poorly addressed diabetes.

We will utilize a cross-sectional analysis of the relationship between diabetes self-management education (DSME) availability (number of providers from 0 through n) and estimated diabetes prevalence (4.1% - 17.6% population). Analyses will compare rural and urban counties (defined as metropolitan/non-metropolitan) and will assess availability across multiple levels of rurality measured using Urban Influence Codes. Statistical procedures will be established after a review of the actual data.

We anticipate characterizing counties as "high diabetes" versus all others and high for minoritized populations versus all others and comparing the availability of DSME in high burden rural counties versus similar urban counties. Additional tables will explore availability across different levels of rurality and look at the intersection between rural and high-minoritized-population status. Three publicly available data sources will be used for the project obtaining the most current information available at each site as of September 2022:

• DSME: Addresses of all accredited DSME providers will be obtained from the two accrediting organizations, the American Diabetes Association and the Association of Diabetes Care and Education Specialists. This information is available on public websites. Addresses will be geocoded to the county.
• High-need counties: Estimated county-level prevalence of diabetes will be obtained from the CDC Places data portal. The Places estimates for diabetes are based on self-report of a diagnosis in the Behavioral Risk Factor Surveillance System surveys and thus constitute a minimum estimate actual prevalence.
• County descriptors: Descriptors including demographics characteristics and health care infrastructure will be obtained from the Area Health Resources File.

Publications

• Prevent or Treat: Availability of Diabetes Self-Management Education and Dialysis in High Need Rural Counties
  Policy Brief
  Rural and Minority Health Research Center
  Date: 03/2024
  In this brief, researchers assess the availability of in-county diabetes self-management education and dialysis across rural and urban counties.