Behavioral Risk Factor Surveillance System; Diabetes Mellitus; Healthcare Disparities; Disease Management; Appalachian Region


Public Health | Social and Behavioral Sciences


Objective: To examine the five-year trend in clinical care and diabetes self-management activities among adults living in the Appalachian state of West Virginia.

Methods: This study used a cross-sectional design with data from the Behavioral Risk Factor Surveillance System in 2010 (N=685) and 2014 (N=958), among noninstitutionalized adults with diabetes. Five-year trend in recommended diabetes clinical care, diabetes self-management activities and diabetes education was analyzed after adjusting for sex, education, income, insurance, age, obesity, comorbid hypertension, race and lifestyle behaviors (exercise and smoking).

Results: A significant increase in percentage of adults with 2 or more A1C tests was noted from 2010 (63.6%) to 2014 (76.4%) in WV. However, annual eye exam decreased by 7% (71.1% to 63.1%) and no statistically significant changes were noted in annual foot exam, number of physician visits and diabetes self-management behaviors (self-monitoring of blood glucose, foot self-exam, and diabetes self-management education). After adjusting for other factors, results from multivariable logistic regressions indicated that adults with diabetes were less likely to have an annual eye exam (AOR 0.70, 95% CI 0.54, 0.91) and more likely to have received 2 or more A1C tests in 2014 (AOR 1.78, 95% CI 1.37, 2.31) compared to 2010.

Conclusion: A1C testing improved but annual eye-exam declined; other indicators of diabetes clinical care and self-management did not change during this five-year period. The findings of low rates of diabetes education, and annual foot/eye exams underscore the need to identify barriers to access and strategies to overcome these barriers.