• Huabin Luo, Ronny A Bell, Nancy L Winterbauer, Lei Xu, Xiaoming Zeng, Qiang Wu, Ann P Rafferty, and Angie M Watson.
• Department of Public Health, Brody School of Medicine (Drs Luo, Bell, Winterbauer, and Rafferty), Department of Health Education and Promotion, College of Health and Human Performance (Dr Xu), and Department of Biostatistics (Dr Wu), College of Allied Health, East Carolina University, Greenville, North Carolina; Department of Psychiatry, University of North Carolina, Chapel Hill, NC (Dr Zeng); and Diabetes Program, Pitt County Health Department, Greenville, North Carolina (Ms Watson).
• J Public Health Manag Pract. 2020 Aug 6.

PurposeThis study aimed to report recent trends in self-reported diabetes self-management education (DSME) participation rates among adults in North Carolina and to compare these rates between rural and urban residents.MethodsData for this analysis were obtained from the NC Behavioral Risk Factor Surveillance System (BRFSS) for the years 2012, 2013, 2015, and 2017, when the survey included the diabetes module. Respondents were classified as having participated in DSME if they answered "Yes" to the question, "Have you ever taken a course or class in how to manage your diabetes yourself?" We used the Rural Urban Continuum Code to classify urban and rural residence. The study sample included 4368 adults 18 years or older with self-reported diabetes. We assessed the changes in DSME participation from 2012 to 2017. We used multiple logistic regression modeling to assess the association between rural residence and DSME participation. All analyses were conducted in Stata 14 and accounted for the survey design of the BRFSS. Statistical significance was set at P < .01.ResultsOverall, the DSME participation rates decreased slightly in the study period, from 55.8% in 2012 to 55.6% in 2013 to 56.5% in 2015 to 52.1% in 2017. By rural-urban residence, the rates were 52.3% versus 57.8% in 2012, 54.0% versus 56.5% in 2013, 48.8% versus 62.0% in 2015, and 46.7% versus 56.1% in 2017. The multiple logistic regression model results showed that rural residents were less likely to have participated in DSME (adjusted odds ratio = 0.78; 95% confidence interval, 0.64-0.94) than urban residents. Adults with higher income and education levels were also more likely to have participated in DSME (P < .01).ConclusionsThe recent BRFSS data showed that the DSME participation rate declined slightly in North Carolina. There were persistent rural-urban disparities in DSME participation, with rural residents showing lower rates, and the gaps seemed to be widening.Implications For Policy Or PracticeContinuous efforts are needed to bring more American Diabetes Association/American Association of Diabetes Educators programs to rural communities and assist persons with diabetes to participate in DSME training to reduce the burden of diabetes. Furthermore, those in rural areas may need additional support.

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