title: Does the shortage of diabetes specialists in regional and rural Australia matter? Results from Diabetes MILES--Australia.
abstract: OBJECTIVE
  To investigate differences in access to services and health outcomes between people living with Type 1 (T1DM) and Type 2 (T2DM) diabetes in rural/regional and metropolitan areas.
  
  
  METHODS
  Diabetes MILES--Australia was a national postal/online survey of persons registered with the National Diabetes Services Scheme. Selected variables, including utilisation of health care services and self-care indicators, were analysed for 3338 respondents with T1DM (41%) or T2DM (59%).
  
  
  RESULTS
  Respondents from rural/regional (n=1574, 48%) and metropolitan areas were represented equally (n=1700, 52%). After adjusting for diabetes duration, demographic and socioeconomic variables, rural/regional respondents with T1DM (RR 0.90, 95% CI 0.83-0.97) and T2DM (RR 0.69, 95% CI 0.59-0.81) were less likely to report consulting an endocrinologist during the past 12 months. Rural/regional respondents with T1DM were more than twice as likely to have accessed a community/practice nurse for diabetes care (RR 2.22, 95% CI 1.25-3.93) while those with T2DM were more likely to have accessed a diabetes educator (RR 1.21, 95% CI 1.07-1.36) or dietician (RR 1.17, 95% CI 1.07-1.36). For the T1DM and T2DM groups were no differences between rural/regional and metropolitan respondents in self-reported hypoglycaemic events during past week and the majority of self-care indicators.
  
  
  CONCLUSIONS
  Despite a lack of access to medical specialists, respondents with T1DM and T2DM living in rural/regional areas did not report worse health or self-care indicators. The results suggest that multidisciplinary primary services in rural areas may be providing additional care for people with diabetes, compensating for poor access to specialists.
authors.affiliation: Rural Clinical School, University of Tasmania, TAS, Australia. Timothy.Skinner@utas.edu.au
authors.forename: Timothy
authors.initials: T
authors.lastname: Skinner
authors.forename: Penny
authors.initials: P
authors.lastname: Allen
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Peach
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Browne
authors.forename: Frans
authors.initials: F
authors.lastname: Pouwer
authors.forename: Jane
authors.initials: J
authors.lastname: Speight
authors.forename: James A
authors.initials: JA
authors.lastname: Dunbar
mesh_terms: D000328:Adult; D001315:Australia; D003920:Diabetes Mellitus; D003922:Diabetes Mellitus, Type 1; D003924:Diabetes Mellitus, Type 2; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019035:Rural Health Services / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D013038:Specialization / Q000706:statistics & numerical data*