PT  - JOURNAL ARTICLE
AU  - Helen N. C. Fu
AU  - Victoria G. Skolnick
AU  - Caroline S. Carlin
AU  - Leif Solberg
AU  - Abagail M. Raiter
AU  - Kevin A. Peterson
TI  - The Effect of Depression and Rurality on Diabetes Control
AID  - 10.3122/jabfm.2020.06.200041
DP  - 2020 Nov 01
TA  - The Journal of the American Board of Family
                Medicine
PG  - 913--922
VI  - 33
IP  - 6
4099  - http://www.jabfm.org/content/33/6/913.short
4100  - http://www.jabfm.org/content/33/6/913.full
SO  - J Am Board Fam Med2020 Nov 01; 33
AB  - Background: Having 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.Methods: This 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.Results: Having 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).Conclusion: Although patients with depression had poorer glycemic control, living in a small rural town reduced the negative association between depression and glycemic control.