Diabetes risk factors, diabetes and diabetes care in a rural Australian community

Objective: To comprehensively describe diabetes-related risk factors, quality of care and patient-perceived barriers to care in a rural community. Design: Cross-sectional mail study, self-completed survey and retrospective chart review. Setting: Community and health services in Corryong, rural Victoria, Australia. Participants: Ninety-seven patients with diabetes and 495 with other diseases in the mail study, 84 with diabetes in the self-completed survey and 101 diabetic patient chart reviews. Main outcome measures: Self-reported lifestyle activities, uptake of health checks, metabolic measures and uptake of medication, and self-reported barriers to diabetes care. Results: Most residents without diabetes had recently had their blood pressure and cholesterol checked; 60.4% were trying to control their weight and 73.9% were exercising regularly (although only 30.7% to an adequate level). Those with diabetes reported a greater uptake of healthy living messages, and had a mean HbA1c of 7.3%, total cholesterol of 5.0mmol L^-1; 12.9% had a diastolic blood pressure ≥ 85 mmHg. Foot checks were infrequent (18%). There was substantial room to increase antiplatelet, blood pressure, antihyperglycaemia and lipid-lowering therapy. Most patients reported psychological (84.5%) and educational (82.1%) barriers to care, with few perceiving physical barriers to care. Conclusion: Living in a rural area with predominantly GP care can be associated with comparatively good metabolic control, although psycho-educational barriers are frequently present. In the wider community, risk factors for diabetes remain common, and the majority have been screened for components of the metabolic syndrome in the previous year.