Prevent or Treat: Availability of Diabetes Self-Management Education and Dialysis in High Need Rural Counties


In this brief, researchers assess the availability of in-county diabetes self-management education (DSME) and dialysis across rural and urban counties.

Key Findings:

Diabetes education:

  • Nationally, 41.0% of all counties contained at least one location where DSME is offered. Rural counties were less likely to have DSME than urban counties (30.1% versus 59.6%).
  • Within rural counties, noncore counties were less likely to have in-county DSME than micropolitan counties (21.3% versus 48.4%).
  • Within high need counties (those in the top quartile for estimated diabetes prevalence), 36.7% of urban counties and 31.3% of micropolitan counties have a DSME site. Among high-need noncore rural counties, however, only 12.8% have this service available.


  • Across the U.S., at least one site for kidney dialysis services is available in 59.2% of all counties. Facilities are present in similar proportions of urban and micropolitan counties (79.5% and 80.5%, respectively) but present in only 31.1% of noncore rural counties.

Both services:

  • Nationally, more rural counties contained dialysis facilities (931 counties; 47.1%) than contained DSME (594; 30.1%). Across 790 high diabetes need counties, 164 (20.8%) have DSME while 417 (52.8%) had an in-county dialysis facility.
Rural and Minority Health Research Center
Janice Probst, Nicholas Yell, Gabriel Benavidez, Mary Katherine McNatt, Teri Browne, Laura Herbert, Whitney Zahnd, Elizabeth Crouch