P-46: Implications for rural youth diagnosed with type 1 diabetes mellitus in the United States: a scoping review
A Patel, S Blout, L Eiland, E Knezevich, S Newpher, E Jones, A Zicari, A Kahkoska, S Khairat, V JewellAbstract
Introduction
Type 1 Diabetes Mellitus (T1DM) is a chronic autoimmune disease that affects major aspects of daily living. Living in rural areas presents a distinct set of challenges that affect children and adolescents with T1DM, which are often overlooked. These issues pertain to technological, psychological, and geographical factors.
Objectives
This review focuses on the classification of a rural environment and the challenges and contributing factors that specifically children and adolescents with T1DM face.
Methods
Researchers searched 5 databases for rural T1DM peer-reviewed literature, producing 5,551 studies. After removing duplication, 3,807 titles and abstracts were screened, and 194 full-text articles were reviewed. This left researchers with 21 articles that met the criteria for rural definitions and patient health outcomes. Out of these articles, 5 of them focused on children and adolescents with T1DM.
Results
Data synthesis identified four primary themes concerning T1DM management in rural populations. First, geographic isolation and resource scarcity were consistently linked to diminished quality of care, which correlated with poorer longitudinal patient health outcomes. Second, technological barriers, specifically limited access to diabetes-related devices in rural settings, were identified as a critical factor negatively impacting hemoglobin A1C levels. Third, acute complications and preexisting comorbidities, most notably diabetic ketoacidosis (DKA), were more prevalent in these regions due to reduced medical care. Finally, psychosocial influences stemmed from geographic isolation, contributing to adverse mental well-being and impaired mood, which further exacerbated suboptimal glycemic control.
Conclusions
This research highlights how geographic isolation can contribute to a multitude of factors, such as access to technology and psychological well-being, which can negatively impact health. A major limitation includes the scarcity of research and studies done with a focus on youth with T1DM.