Finding process of care inequities in diabetes treatment

Diabetes management can be challenging at the best of times. But those living in rural areas face particular challenges when treatment intensification is required, notes a new research paper led by Danielle Nagy, a fourth-year PhD candidate at the University of Alberta’s Faculty of Pharmacy and Pharmaceutical Sciences.

Her efforts to uncover specific challenges—beyond just infrastructure—for rural Alberta patients in accessing medications for type 2 diabetes has earned Nagy this year’s AFPC/Canadian Foundation for Pharmacy Graduate Student Award for Pharmacy Practice Research.

The retrospective cohort study looked at how sulfonylureas, the most common antihyperglycemic drug class used for the intensification of type 2 diabetes after initial metformin therapy, are being dispensed across the province of Alberta. Nagy and her team discovered that over time sulfonylureas use declined across the province, except in rural areas where there was up to a four-year delay in decline compared to urban and metropolitan locations. The sustained use of sulfonylureas in rural areas, when newer options are available, was concerning.

Determining why there was a delay in using newer antihyperglycemic agents at first treatment intensification in rural settings requires further investigation, but the researchers suggest a possible explanation may include barriers to implementing best practices in health care and overall differences in the process of care by rural clinicians.

“We conducted this research to elucidate a clearer picture of rural health care and its challenges,” noted the researchers. “Our findings are troubling and provide a basis to expand understanding of the influence of place of residence on processes of care.” The study results were published in the March 2023 issue of Diabetes Care.