• Helen N C Fu, Victoria G Skolnick, Caroline S Carlin, Leif Solberg, Abagail M Raiter, and Kevin A Peterson.
• From the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN (HF); College of Liberal Arts, University of Minnesota-Twin Cities, Minneapolis (VGS); Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN (CC); HealthPartners Institute, Minneapolis MN (LS); College of Liberal Arts, University of Minnesota-Twin Cities, Minneapolis (AMR); Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis (KAP).
• J Am Board Fam Med. 2020 Nov 1; 33 (6): 913-922.

BackgroundHaving depression and living in a rural environment have separately been associated with poor diabetes outcomes, but there little is known about the interaction between the 2 risk factors. This study investigates the association of depression and rurality with glycemic control in adults, as well as their interaction.MethodsThis is a repeated cross-sectional study with data collected from 2010 to 2017 (n = 1,697,173 patient-year observations), comprising a near-complete census of patients with diabetes in Minnesota. The outcome of interest was glycemic control defined as hemoglobin A1c under 8%. We used a logit model with clinic-level random effects to predict glycemic control as a function of depression, patient rurality, and their interaction, adjusted for differences in observed characteristics of the patient, clinic, and patient's neighborhood.ResultsHaving depression was associated with lower probability of achieving glycemic control (P < .001). Although rurality alone had no association with glycemic control, significant interactions existed between depression and rurality. Living in a small rural town mitigated the negative association between depression and glycemic control (P < .001).ConclusionAlthough patients with depression had poorer glycemic control, living in a small rural town reduced the negative association between depression and glycemic control.© Copyright 2020 by the American Board of Family Medicine.

19 keywords...

hide…