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Quality of care in rural youth with type 1 diabetes: a cross-sectional pilot assessment
  1. Kyle S Stumetz1,
  2. Joyce P Yi-Frazier2,
  3. Connor Mitrovich3,
  4. Kathaleen Briggs Early4
  1. 1PNWU, College of Osteopathic Medicine, Yakima, Washington, USA
  2. 2Seattle Children's Research Institute, Seattle, Washington, USA
  3. 3A.T. Still University of Health Sciences, Kirksville College of Osteopathic Medicine, Kirksville, Missouri, USA
  4. 4Department of Biomedical Sciences, PNWU, College of Osteopathic Medicine, Yakima, Washington, USA
  1. Correspondence to Dr Kathaleen Briggs Early; kearly{at}


Background Type 1 diabetes mellitus (T1DM) presents a significant health burden for patients and families. The quality of care (QOC) among those living in rural communities is thought to be subpar compared with those in urban communities; however, little data exist to reflect this, especially in pediatric diabetes.

Objective The purpose of this pilot study was to investigate diabetes QOC among families living in rural versus urban areas. 6 QOC markers were used to compare youth with T1DM: appointment adherence, patient–provider communication, diabetes education during clinic visit, congruency with diabetes standards of care, diabetes self-management behaviors, and diabetes-related hospitalizations.

Research design and methods Participants were rural or urban adult caregivers of youth ages 2–18 with ≥10-month history of T1DM receiving treatment at Seattle Children's Hospital, USA. Participants were from rural areas of central Washington, or urban areas of western Washington. Caregivers completed a 26-item survey pertaining to the 6 QOC markers. The 6 QOC markers were compared across 61 participants (34 rural, 27 urban), to determine how diabetes care quality and experiences differed. Data were collected over 12 months. Groups were compared using t-tests and χ2 tests, as appropriate.

Results Compared with urban families, rural families reported significantly lower income and a 4-fold greater usage of public insurance. Among the QOC measures, rural participants were significantly worse off in the appointment adherence, patient–provider communication, and hospitalizations categories. Congruence with diabetes standards of care (foot care only) was also significantly poorer in rural participants.

Conclusions The burden of travel in conjunction with the lack of resources in this rural population of families with T1DM youth is cause for concern and warrants further research.

  • Pediatric Type 1 Diabetes
  • Quality of Care
  • Rural Health
  • Youth

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  • Contributors All authors contributed to the interpretation of the findings, drafting, revising of the manuscript, and approving the final draft. CM did the bulk of recruiting and collected most of the data. JPY-F and CM analyzed the data. JPY-F and KBE conceived the study design and wrote the initial proposal.

  • Funding PNWU Seed Fund.

  • Competing interests None declared.

  • Ethics approval PNWU IRB and Seattle Children's IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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