SAT-843 - Rural Residence as an Independent Determinant of Poor Glycemic Control in Adults with Type 2 Diabetes: The NORDIA-RD Study

BACKGROUND / OBJECTIVE
Rural residence is a recognized social determinant of health, yet its independent association with glycemic control in type 2 diabetes mellitus (T2DM) populations of the Caribbean remains poorly characterized. Structural barriers including limited specialist access, restricted medication availability, and lower health literacy may amplify metabolic risk in rural communities. We aimed to evaluate whether rural residence constitutes an independent determinant of poor glycemic control (HbA1c ≥7%) in adults with T2DM in the northern Dominican Republic.
METHODS
Cross-sectional analytical study (NORDIA-RD) of 877 adults (67.3% female; mean age 60.8±12.0 years) with confirmed T2DM attending outpatient facilities across the Cibao region (December 2024–November 2025). Residence was categorized as urban or rural. Poor glycemic control was defined as HbA1c ≥7%. Associations were assessed using Chi-square and Goodman–Kruskal gamma statistics. Binary logistic regression adjusted for age, sex, health insurance type, therapeutic adherence (MMAS-8), and physical activity (WHO categories). Analyses performed in IBM SPSS v25.0 and R v4.3.1 (p < 0.05). AI-assisted drafting disclosed per ENDO 2026 policy; all analyses performed by the research team.
RESULTS
Poor glycemic control prevalence was 61.2%. A significant positive association was observed between rural residence and poor glycemic control (χ² = 34.153; p < 0.001; γ = 0.297). Urban patients showed 213 cases of adequate control and 242 of poor control, whereas rural patients had 127 adequate and 295 poor control cases, indicating a higher burden in rural areas.
No significant association was found between rural residence and therapeutic adherence (p = 0.248), suggesting other mechanisms beyond medication compliance. Logistic regression confirmed rural residence as an independent predictor of poor glycemic control (OR = 2.04; 95% CI: 1.55–2.70; p < 0.001).
CONCLUSIONS
Rural residence was independently associated with approximately twice the odds of poor glycemic control in T2DM patients in the northern Dominican Republic, independent of therapeutic adherence. This represents the first evidence of a rural–urban glycemic disparity in a real-world T2DM Caribbean cohort. Geographically targeted strategies including mobile health units, telemedicine, and community-based metabolic screening are urgently needed.

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