Newswise – Evidence shows that people living in rural areas of the United States are more likely to have diabetes and have difficulty managing their disease than people living in suburbs and cities. Now researchers at the University of Maryland School of Medicine have determined the devastating impact of this health disparity.

People who live in small towns have a significantly higher risk of eight diabetes-related complications – including heart attacks and kidney disease – and failure compared to people who live in well-populated suburbs and cities, according to a new study published in the journal Diabetes treatment.

The study analyzed health insurance data from nearly 3 million adults with diabetes in the U.S. over a 10-year period ending in 2021. They found that people living in small towns (population size 2,500) were 10 percent more likely to have diabetes to 50,000 people) were 5 percent more likely to have heart failure and about 4 percent more likely to have end-stage kidney disease compared to people living in larger cities.

“Those who live in rural areas have a higher risk of developing 8 of the 11 complications we measured compared to people who live in cities.” said the study’s corresponding author Rozalina McCoy, MDAssociate Professor of Medicine at UMSOM and Director of the Precision Medicine and Population Health Program at the University of Maryland Institute for Health Computing. “They were 15 percent more likely to have dangerously low blood sugar levels, which clearly indicates that their diabetes is not being properly managed.”

About 14 percent of study participants lived in small towns, compared to 83 percent who lived in cities. Another 3 percent lived in remote areas with fewer than 2,500 people living within a defined geographic area in their county.

“Although our study did not address why these differences exist, we know that people living outside urban areas are less likely to receive care from diabetes specialists, receive diabetes self-management training, and be monitored for diabetes complications. “ said study co-author Esa Davis, MD, Professor of Family and Community Medicine and Senior Associate Dean of Population and Community Medicine at UMSOM. “Our research builds on these fundamental findings to demonstrate a possible impact of these differences on preventable diabetes complications.”

Interestingly, the study found that people living in remote areas have a lower risk of developing some diabetes complications. Compared to people who lived in small towns, they were 15 percent less likely to have dangerously high blood sugar levels and 6 percent less likely to develop heart failure.

However, this may not mean that they actually have fewer complications: Because the study team relied on insurance information to identify diabetes complications, this complication would not be captured if people did not have access to medical care. Dr. McCoy noted that this finding further highlighted the hurdles to care in remote areas: Patients are likely to experience emergencies involving high blood sugar levels and heart failure, but are unable to go to the emergency room or hospital for diagnosis and treatment.

The researchers controlled for age, gender, health insurance type, diabetes type, medication use and chronic health conditions.

While the relative increase in the risk of diabetes complications was modest for those living in rural areas, it may add up to a tremendous health burden since more than 5 million Americans with diabetes live in small towns.” said Mark T. Gladwin, MD, He is the John Z. and Akiko K. Bowers Distinguished Professor and Dean of UMSOM and Vice President for Medical Affairs at the University of Maryland, Baltimore. There is an urgent need to improve physician and medical provider and hospital services for people in rural communities, and we are planning a new program to bring our medical students to Maryland’s rural Eastern Shore to help address this disparity to eliminate.”

Researchers from the Mayo Clinic and Yale School of Medicine were co-authors of this study. The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (grant K23DK114497).

About the University of Maryland School of Medicine

Now in its third century, the University of Maryland School of Medicine was founded in 1807 as the first public medical school in the United States. It remains one of the fastest-growing, world-class biomedical research organizations in the world – with 46 academic departments, centers, institutes and programs and a faculty of more than 3,000 physicians, scientists and allied health professionals, members of the National Academy of Medicine and the National Academy of Medicine Sciences and a distinguished two-time winner of the Albert E. Lasker Award in Medical Research. With an operating budget of more than $1.2 billion, the School of Medicine works closely with the University of Maryland Medical Center and the Medical System to provide research-intensive, academic and clinically based care to nearly 2 million patients each year. The School of Medicine has more than $500 million in extramural funding, with most of its academic departments ranking at the top in research funding among all medical schools in the country. As one of the seven professional schools that make up the University of Maryland, Baltimore campus, the School of Medicine has a total population of nearly 9,000 faculty and staff, including 2,500 students, trainees, residents and fellows. The School of Medicine, which is considered the Eighth highest One of the top public medical schools in research productivity (according to the Association of American Medical Colleges profile), it is an innovator in translational medicine, with 606 active patents and 52 start-up companies. In the latest US News & World Report ranking of best medical schools released in 2023, the UM School of Medicine is ranked first Ranked 10th among 92 public medical schools in the US and in the top 16 percent (#32) out of all 192 public and private ones Medical schools in the USA. The School of Medicine operates locally, nationally and globally with research and treatment facilities in 36 countries around the world. Visit

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