Health Education Disparities in Patients Diagnosed With Type 2 Diabetes Mellitus Using Data From the National Ambulatory Medical Care Survey for the Years 2012 to 2019

Abstract

Purpose

The purpose of the study was to examine the relationship between receipt of diet/nutrition, exercise, weight reduction, and diabetes education and various demographic and clinical factors among adults with type 2 diabetes mellitus (T2DM) using 2012-2019 National Ambulatory Medical Care Survey (NAMCS) data.

Methods

This retrospective, cross-sectional study included adults ages ≥18 diagnosed with T2DM in the NAMCS from 2012 to 2019. Plots of the annual percentage of visits (and associated 95% CIs) at which each type of education was received were constructed. Chi-square tests and multivariable logistic regression models were employed to examine the association between receipt of each education types and various factors collected in the NAMCS.

Results

A total of 11 525 patient visits were analyzed. Education was provided at 16.7% of visits for exercise, 24.3% for diet/nutrition, 7.5% for weight reduction, and 16.6% for diabetes. Adjusting for available covariates, higher body mass index increased the odds of receiving education on exercise. Diet/nutrition education was more common in visits with physicians and allied health providers and less common with surgical or medical specialists compared to primary care, as was exercise education. Tobacco users were less likely to receive weight reduction education. Limited racial or ethnic disparities were observed, but rural visits were less likely than urban visits to receive exercise and weight reduction education.

Conclusion

Although racial and ethnic disparities in diabetes education were not observed when adjusting for available covariates, geographic, specialty-based, and tobacco-use-related disparities persist, particularly affecting rural areas, specialist care, and smokers. These disparities highlight the necessity of targeted interventions to enhance access to education and improve health outcomes.