American Physican Therapy Combined Sections Meeting

Document Type

Conference Proceeding





Type 2 diabetes poses significant health concerns and severe complications can result. The prevalence of type 2 diabetes is greater in rural than urban areas with rural populations exhibiting higher blood glucose (A1C). The purpose of this study was to determine whether health related quality of life (QOL) varies by gender and diabetes control (A1C) in rural persons with type 2 diabetes.


We surveyed 615 persons with type 2 diabetes who receive care at a critical access hospital that serves a seven county rural area in a Midwestern state.


This study was a cross-sectional mail survey including a questionnaire assessing demographic characteristics, health related quality of life (QOL) using the diabetes specific QOL tool, D-39, which covers five dimensions of a persons’ life: energy and mobility, diabetes control, anxiety and worry, social burden, and sexual functioning. We analyzed associations between A1C levels and survey responses using descriptive statistics and Spearman correlations.


We received a 42% response rate with an even distribution of males and females. The median age for females was 76 years, males was 72 years and the majority were white (95%). The average years since diagnosis was 13.4 years (11 years for males and 9.5 for females).

Spearman correlations were computed for D-39 subscales, overall perceived severity and QOL, and A1C. Positive correlations exist between overall perceived severity and the QOL dimensions of diabetes control (p<.001), anxiety and worry (p<.001), social burden (p<.001), sexual functioning (p<.001), and energy and mobility (p<.001). Overall QOL rating is positively correlated with anxiety and worry (p=.011), social burden (p=.002) and energy and mobility (p<.001). Hemoglobin A1C is positively correlated with the dimensions of diabetes control (p<.001), anxiety and worry (p=.006), social burden (p<.001), and sexual functioning (p=.030). When comparing the subscale dimension means between gender there is a significant difference only in reports of the sexual functioning dimension (p<.001). Additional gender differences are related to perceived severity. When at low perceived severity females have a lower A1C and at high values of perceived severity males have a lower A1C.


Since diabetes control is largely due to self-management, it is important to consider the associations between the QOL dimensions, diabetes control (A1C) and gender. These results could be important for implementing successful intervention strategies for glycemic control (a potential mediator between diabetes and QOL) in rural critical access hospitals.

Clinical Relevance

Although gender is commonly reported in published studies about diabetes, differences have not been routinely analyzed. A better understanding of the relationship of perceived QOL and the impact on diabetes control and gender differences can assist the physical therapist in their role in providing optimal care for older adults with type 2 diabetes in rural communities.