Improving Diabetes Care in Rural Communities: An Overview of Current Initiatives and a Call for Renewed Efforts

Diabetes is a crucial health issue that affects 180 million people worldwide, including 23.6 million people residing in the United States.1,2 Each year, diabetes is responsible for ~ 5% of all deaths globally (10-15% in the United States), and its prevalence is steadily increasing.1,2 According to the International Diabetes Federation, the number of people living with diabetes is projected to reach 380 million by 2025.3 Because of its widespread prevalence and potentially debilitating impact, diabetes has become an international and national priority area of health concern.2,4 Although the importance of addressing diabetes is well recognized, translating clinical, evidence-based management interventions for practical implementation has proven difficult, particularly for rural communities.5,6 Individuals living in rural communities often encounter difficulties obtaining appropriate health care because of distance from health clinics, financial limitations, cultural barriers, mistrust, communication issues, and high rates of health illiteracy. In this overview, we will discuss the prevalence and severity of diabetes in rural areas, as well as some of the barriers to health access and disease management that have led to observed disparities between rural and urban areas. We will then describe strategies currently being implemented to improve diabetes care in rural areas, including some of our own experiences and efforts in rural Alabama. Although a number of health disparities exist between rural and urban areas, including injury-related deaths, heart disease rates, and cancer rates, diabetes ranks as one of the most significant health concerns.4 Compared to urban areas, rural areas experience an ~ 17% higher diabetes prevalence rate.7 In fact, the impact of diabetes in rural communities has earned it prominence as a top-three priority area in Rural Healthy People 2010. 8 Despite the high prevalence of diabetes in rural communities, there …