Diabetes Education Desert: Regional Disparity between Diabetes Prevalence and Diabetes Self-Management Education Programs in Texas

Diabetes is a major chronic disease that was the seventh leading cause of death in the United States in 2017. Although diabetes self-management education (DSME) programs have been implemented to promote patients' self-management skills, the disease continues to grow and some regions have a heavier burden of diabetes diagnoses than others. Focusing on the unbalanced diabetes prevalence across counties, this study aims to identify regional distribution of diabetes education programs in Texas counties, and explore whether diabetes prevalence is worse in certain counties that are geographically isolated from DSME programs. Data from the Centers for Disease Control and Prevention, American Diabetes Association, and American Association of Diabetes Educators were analyzed using ESRI ArcGIS software. When the authors geocoded 167 DSME programs in Texas, it was found that 47 programs (28.7%) were concentrated in 1 single county, and only 49 counties (19.3%) of the total counties (n = 254) had at least 1 DSME program. It also was revealed that the 25 counties (10%) with the highest diabetes prevalence had only 4 DSME programs (2.4%), indicating that there are still marginalized areas with no access to diabetes education programs. Considering the distance from each county's center to the nearest DSME program and diabetes prevalence, 3 counties were identified as diabetes education deserts. When designing, implementing, and evaluating strategies to reduce the burden of diabetes, policy makers and health care providers should account for the existing regional disparity in diabetes education and its impact on diabetes prevalence.