Type 2 Diabetes Management in Aotearoa New Zealand: A Comparison of Urban and Rural Primary Care Clinics

Abstract

Objective

To examine the demographic differences between individuals with Type 2 Diabetes (T2D) enrolled in rural and urban clinics and evaluate the quality of care they receive.

Design

Cross-sectional observational study.

Setting

Primary care data from four large Primary Healthcare Organisations across the Auckland and Waikato regions of New Zealand.

Participants

Patients aged 18–75 years with T2D from February 2021 to August 2022.

Main Outcomes Measures

Associations between rurality and sociodemographic variables, clinical measures, and prescribing rates.

Results

A total of 56 937 patients with T2D were included, with 85.3% enrolled in urban practices and 14.7% in rural. Rural clinics had a significantly higher proportion of Māori individuals than urban clinics (31.4% vs. 17.4%). Patients in rural clinics had lower but not clinically significant reductions in mean HbA1c, LDL-c, blood pressure, and eGFR than those in urban clinics; however, the number of laboratory tests completed during the study period was lower in rural clinics. Māori were less likely to receive HbA1c and uACR tests than non-Māori. Clinically indicated prescribing for metformin (79.1% vs. 72.5%), ACE inhibitors (80.5% vs. 75.2%), and statins (61.2% vs. 54.4%) was higher in patients enrolled in urban than rural clinics (all p < 0.05), and regression showed lower odds of insulin (OR: 0.65, 95% CI: 0.61–0.69) and SGLT2i/GLP1RA (OR: 0.87, 95% CI: 0.82–0.93) prescribing in rural clinics (both p < 0.001).

Conclusion

Targeted strategies are needed to address the disparities in T2D care for patients in rural clinics, as well as Māori, particularly optimizing medication prescribing and laboratory tests to improve overall care.