title: Diabetic education in rural areas.
abstract: BACKGROUND
  Diabetes mellitus type II is a growing concern in the USA, with 6% of the population diagnosed with diabetes and another 5% having pre-diabetes. The prevalence of diabetes is 17% higher in rural areas than in central cities{1}. Adult diabetics living in rural areas often see negative outcomes related to their limited access to care, cultural barriers, and lack of educational resources. This article seeks to evaluate best evidence-based strategies directed at improving diabetic outcomes of rural populations through hemoglobin A1C (HbA1C) reductions.
  
  
  METHODS
  A search of Medline, CIHNAL, PubMed, and Sage Pub was undertaken. The search was structured around the following key terms: adult, diabetes, education, hemoglobin a1c, and rural. The search limits were set to English-language publications between 2004 and 2012 in industrialized countries. Only articles from scholarly, peer-reviewed publications were considered. Literature that used an inpatient setting, focused on children or adolescents, and did not meet any inclusion criteria were excluded from this review.
  
  
  RESULTS
  A total of 15 articles met the selection criteria from the 1819 citations sourced from the search. After reviewing the sources, nutritional patient education, motivational counseling and lifestyle modifications were found to be the most influential factors that favorably changed measurable outcomes for this population. Education for providers did not have an appreciable effect on patient outcomes.
  
  
  CONCLUSIONS
  This review adds to the literature by outlining best-practice guidelines for evidence-based practice based on current research. Primary care providers in rural areas should encourage their patients to actively participate in diabetes education when possible, and provide this education in a culturally competent manner.
authors.affiliation: Univeristy of Cincinnati, Cincinnati, Ohio, USA. maezla@mail.uc.edu.
authors.forename: L
authors.initials: L
authors.lastname: Maez
authors.affiliation: Univeristy of Cincinnati, Cincinnati, Ohio, USA. ericksln@mail.uc.edu).
authors.forename: L
authors.initials: L
authors.lastname: Erickson
authors.affiliation: Univeristy of Cincinnati, Cincinnati, Ohio, USA. lmwright8@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Naumuk
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D004032:Diet; D015444:Exercise; D006442:Glycated Hemoglobin; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D010353:Patient Education as Topic / Q000379:methods*; D012424:Rural Population; D014481:United States
chemical_list: D006442:Glycated Hemoglobin