{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T19:12:29Z","timestamp":1781118749458,"version":"3.54.1"},"reference-count":34,"publisher":"American Diabetes Association","issue":"3","license":[{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"crossref","award":["K25DK136966"],"award-info":[{"award-number":["K25DK136966"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Previous studies have identified limited access to diabetes self-management education and support (DSMES) programs in many U.S. communities. This retrospective cohort study examines rural\u2013urban differences in DSMES use among individuals newly diagnosed with type 2 diabetes using the Arkansas All-Payer Claims Database from 2015 to 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>A cohort of 42,875 individuals covered by commercial or Medicare\/Medicare Advantage insurance was identified. Generalized estimating equations, based on multivariable logistic regression, were used to assess the association between rural residence and DSMES use, accounting for clustering at the county level. The model adjusted for demographic characteristics, insurance type, diabetes complication severity score, and county-level factors, including primary care shortages, median household income, and density of DSMES-recognized programs per 10,000 individuals with diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>DSMES use was lower in rural compared with urban areas (3.4% vs. 6.2%; P &amp;lt; 0.01). However, after adjusting for county-level factors, rural\u2013urban differences were not statistically significant (odds ratio [OR] 0.83; 95% CI 0.47\u20131.47; P = 0.52). Individuals in the lowest quartile of household income had lower odds of DSMES use (OR 0.65; 95% CI 0.46\u20130.91; P = 0.01). Those in counties with a higher density of DSMES programs had higher odds of DSMES use (quartile 2: OR 1.75; 95% CI 1.22\u20132.50; P &amp;lt; 0.01; quartile 3: OR 1.53; 95% CI 1.10\u20132.12; P = 0.01; quartile 4: OR 1.40; 95% CI 1.04\u20131.90; P = 0.03).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Findings suggest that structural factors, including income and program availability, explain many of the rural\u2013urban differences in DSMES use. Geographic context should be considered in efforts to improve access to diabetes education.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/doc25-0065","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:27:11Z","timestamp":1776097631000},"page":"423-430","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":0,"title":["Rural\u2013Urban Differences in Use of Diabetes Self-Management Education and Support in Arkansas, 2015\u20132019"],"prefix":"10.2337","volume":"1","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8390-9118","authenticated-orcid":false,"given":"Mandana","family":"Rezaeiahari","sequence":"first","affiliation":[{"name":"Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences 1 , Little Rock, AR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1421-6606","authenticated-orcid":false,"given":"Joseph A.","family":"Henske","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences 2 , Little Rock, AR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley C.","family":"Martin","sequence":"additional","affiliation":[{"name":"Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences 3 , Little Rock, AR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayo","family":"Fujimoto","sequence":"additional","affiliation":[{"name":"Health Promotion & Behavioral Sciences Department, University of Texas Health Science Center at Houston 4 , Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey M.","family":"Curran","sequence":"additional","affiliation":[{"name":"Departments of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences 5 , Little Rock, AR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moiz","family":"Bhai","sequence":"additional","affiliation":[{"name":"College of Business, Health, and Human Services, University of Arkansas at Little Rock 6 , Little Rock, AR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark L.","family":"Williams","sequence":"additional","affiliation":[{"name":"Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences 1 , Little Rock, AR"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2026,4,13]]},"reference":[{"key":"2026061014522610400_B1","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.2337\/diacare.25.7.1159","article-title":"Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control","volume":"25","author":"Norris","year":"2002","journal-title":"Diabetes Care"},{"key":"2026061014522610400_B2","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1089\/pop.2018.0175","article-title":"Evaluating the impact of year-long, augmented diabetes self-management support","volume":"22","author":"Bluml","year":"2019","journal-title":"Popul Health Manag"},{"key":"2026061014522610400_B3","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1007\/s12020-016-1168-2","article-title":"Diabetes self-management education reduces risk of all-cause mortality in type 2 diabetes patients: a systematic review and meta-analysis","volume":"55","author":"He","year":"2017","journal-title":"Endocrine"},{"key":"2026061014522610400_B4","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1177\/0145721711416256","article-title":"Assessing the value of the diabetes educator","volume":"37","author":"Duncan","year":"2011","journal-title":"Diabetes Educ"},{"key":"2026061014522610400_B5","first-page":"1045","article-title":"Diabetes self-management education and training among privately insured persons with newly diagnosed diabetes-United States, 2011-2012","volume":"63","author":"Li","year":"2014","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2026061014522610400_B6","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1177\/0145721720987936","article-title":"Diabetes self-management education and support in adults with type 2 diabetes: a consensus report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association","volume":"47","author":"Powers","year":"2021","journal-title":"Sci Diabetes Self Manag Care"},{"key":"2026061014522610400_B7","doi-asserted-by":"crossref","first-page":"E615","DOI":"10.1161\/CIR.0000000000000753","article-title":"Call to action: rural health: a presidential advisory from the American Heart Association and American Stroke Association","volume":"141","author":"Harrington","year":"2020","journal-title":"Circulation"},{"key":"2026061014522610400_B8","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/j.1748-0361.2009.00259.x","article-title":"Diabetes burden and access to preventive care in the rural United States","volume":"26","author":"Krishna","year":"2010","journal-title":"J Rural Health"},{"key":"2026061014522610400_B9","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1370\/afm.2962","article-title":"Disparities in diabetes care: differences between rural and urban patients within a large health system","volume":"21","author":"Foss","year":"2023","journal-title":"Ann Fam Med"},{"key":"2026061014522610400_B10","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1177\/0145721713480002","article-title":"Racial\/ethnic, regional, and rural\/urban differences in receipt of diabetes education","volume":"39","author":"Brown-Guion","year":"2013","journal-title":"Diabetes Educ"},{"key":"2026061014522610400_B11","doi-asserted-by":"crossref","first-page":"e0254579","DOI":"10.1371\/journal.pone.0254579","article-title":"Geographic disparities and temporal changes of diabetes prevalence and diabetes self-management education program participation in Florida","volume":"16","author":"Khan","year":"2021","journal-title":"PLoS One"},{"key":"2026061014522610400_B12","unstructured":"Arkansas Center for Health Improvement\n          . 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