Journal of Community Health

, Volume 29, Issue 1, pp 29–44 | Cite as

A Comparison of Diabetes Care in Rural and Urban Medical Clinics in Alabama

  • Miranda R. Andrus
  • Kristi W. Kelley
  • Lisa M. Murphey
  • Katherine C. Herndon


This study sought to determine the differences in the level of diabetes care of patients in a rural family practice clinic and an urban internal medicine clinic in Alabama. Medical records of patients with diabetes were reviewed and management practices were compared to current American Diabetes Association (ADA) standards of care. The rural practice had fewer patients at goal A1c, goal LDL, and goal blood pressure. Rural patients were also less likely to receive screening and preventative services such as lipid profiles, eye examinations, microalbumin screening, aspirin therapy, and vaccinations than urban patients. Although, adherence to the ADA standards of care was lower with rural patients, the results suggest that there exists significant opportunity to improve the delivery of diabetes care services to both patient populations.

diabetes mellitus treatment standards rural health 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    National Diabetes Fact Sheet: National estimated and general information on diabetes in the United States. Centers for Disease Control and Prevention, 2000. Available at Google Scholar
  2. 2.
    American Diabetes Association. Diabetic retinopathy. Diabetes Care 2002; 25(suppl 1):S90–S93.Google Scholar
  3. 3.
    American Diabetes Association. Diabetic nephropathy. Diabetes Care 2002; 25(suppl 1):S85–S89.Google Scholar
  4. 4.
    American Diabetes Association. Management of dyslipidemia in adults with diabetes. Diabetes Care 2002; 25(suppl 1):S74–S77.Google Scholar
  5. 5.
    The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329:977–986.Google Scholar
  6. 6.
    UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352:837–853.Google Scholar
  7. 7.
    American Diabetes Association. Implications of the United Kingdom prospective diabetes study. Diabetes Care 2001; 24(suppl 1):S28–S32.Google Scholar
  8. 8.
    American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care 2002; 25(suppl 1):S33–S49.Google Scholar
  9. 9.
    American Diabetes Association. Tests of glycemia in diabetes. Diabetes Care 2002; 25(suppl 1): S97–S99.Google Scholar
  10. 10.
    Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the national cholesterol education program expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA 2001; 285:2486–2497.Google Scholar
  11. 11.
    American Diabetes Association. Treatment of hypertension in adults with diabetes. Diabetes Care 2002; 25(suppl 1):S71–73.Google Scholar
  12. 12.
    American Diabetes Association. Aspirin therapy in diabetes. Diabetes Care 2002; 25(suppl 1):S78–S79.Google Scholar
  13. 13.
    American Diabetes Association. Preventive foot care in people with diabetes. Diabetes Care 2002; 25(suppl 1):S69–S73.Google Scholar
  14. 14.
    American Diabetes Association. Immunization and the prevention of influenza and pneumococcal disease in people with diabetes. Diabetes Care 2002; 25(suppl 1):S117–S119.Google Scholar
  15. 15.
    The State of Health Care Quality: 2002. Washington, DC, The National Committee for Quality Assurance, 2002.Google Scholar
  16. 16.
    Saaddine JB, Engelgau MM, Beckles GL, Gregg EW, Thompson TJ, Venkat Narayan KM. A diabetes report card for the United States: quality of care in 1990s. Ann Intern Med 2002; 136:565–574.Google Scholar
  17. 17.
    Zoorob JR, Mainous AG. Practice patterns of rural family physicians based on the American Diabetes Association standards of care. J Community Health 1996; 21:175–181.Google Scholar
  18. 18.
    Miller CD, Phillips LS, Tate MK, Porwoll JM, Rossman SD, Cronmiller N, Gebhart SSP. Meeting American Diabetes Association guidelines in endocrinology practice. Diabetes Care 2000; 23:444–448.Google Scholar
  19. 19.
    Dansky KH, Dirani R. The use of health care services by people with diabetes in rural areas. J Rural Health 1998; 14: 129–137.Google Scholar
  20. 20.
    Probst JC, Moore CG, Baxley EG, Lammie JJ. Rural-urban differences in visits to primary care physicians. Fam Med 2002; 34:609–615.Google Scholar
  21. 21.
    Hartley D, Quam L, Lurie N. Urban and rural differences in health insurance and access to care. J Rural Health 1994; 10:98–108.Google Scholar
  22. 22.
    Strickland J, Strickland DL. Barriers to preventive health services for minority households in the rural south. J Rural Health 1996; 12:206–217.Google Scholar

Copyright information

© Human Sciences Press, Inc. 2004

Authors and Affiliations

  • Miranda R. Andrus
    • 1
  • Kristi W. Kelley
    • 2
  • Lisa M. Murphey
    • 2
  • Katherine C. Herndon
    • 3
  1. 1.Auburn University Harrison School of PharmacyUniversity of Alabama College of Community Health SciencesTuscaloosa
  2. 2.School of PharmacyAuburn University HarrisonUSA
  3. 3.Pfizer Pharmaceuticals GroupUSA

Personalised recommendations