Are Guideline-concordant Processes of Care Consistent Across the Rural–Urban Continuum? A Retrospective Cohort Study of Adults Newly Treated for Type 2 Diabetes

ObjectiveTo explore the association between place of residence (metropolitan, urban, rural) and guideline concordant processes of care in the first year of type 2 diabetes management. MethodsWe conducted a retrospective cohort study of new metformin users between April 2015 and March 2020 in Alberta.Outcomes were identified as guideline concordant processes of care through the review of clinical practice guidelines and published literature.Using multivariable logistic regression, the following outcomes were examined by place of residence: dispensation of a statin, angiotensin-converting-enzyme-inhibitor (ACEi) or angiotensin-II-receptor-blocker (ARB), eye examination, and glycated hemoglobin A1C, cholesterol, and kidney function testing. ResultsOf 60,222 new metformin users, 67% resided in a metropolitan area, 10% in urban, and 23% in rural.After confounder adjustment, rural residents were less likely to have a statin dispensed (aOR0.83;95%CI:0.79-0.87)or undergo cholesterol testing (aOR0.86;95%CI:0.83-0.90),compared to metropolitan residents.In contrast, rural residents were more likely to receive A1C and kidney function testing (aOR1.14;95%CI:1.08-1.21 and aOR1.17;95%CI:1.11-1.24,respectively).ACEi/ARB use and eye examinations were similar across place of residence. ConclusionsProcesses of care varied by place of residence.Limited cholesterol management in rural areas is concerning because this may lead to increased cardiovascular outcomes.