The Effect of Depression and Rurality on Diabetes Control

J Am Board Fam Med. 2020 Nov-Dec;33(6):913-922. doi: 10.3122/jabfm.2020.06.200041.

Abstract

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.

Keywords: Cross-Sectional Studies; Depression; Diabetes Mellitus; Glycated Hemoglobin A; Hyperglycemia; Logistic Models; Minnesota; Risk Factors; Rural Health Services.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Blood Glucose
  • Cross-Sectional Studies
  • Depression / epidemiology
  • Diabetes Mellitus* / epidemiology
  • Diabetes Mellitus, Type 2*
  • Glycated Hemoglobin / analysis
  • Humans

Substances

  • Blood Glucose
  • Glycated Hemoglobin A