Introduction and Objective: To explore rural-urban differences in follow-up in primary and endocrinology care among adults with diabetes who experienced hyperglycemic or hypoglycemic crises requiring emergency department (ED) or hospital care.Methods: This is a retrospective cohort study leveraging electronic health record data from a large integrated healthcare delivery system in the U.S. Upper Midwest between January 1, 2020 and October 1, 2024. We identified adults (≥18 years) with diabetes who had an ED visit or hospitalization with a primary diagnosis of hypoglycemic or hyperglycemic crisis, subset to those in rural areas (population <20,000) or nonrural (urban) areas, and quantified differences in rates of follow-up with primary care and endocrinology at 30, 60 and 90 days following discharge.Results: We identified 1,258 individuals experiencing a hypoglycemic or hyperglycemic crisis; 23.1% from rural and 76.9% from urban areas. Rural residents had fewer primary care clinician visits (39.5% vs 49.3%, P= 0.003) and endocrinologist visits (8.6% vs 16.3%, P= 0.001) than urban residents within 30 days. Lower visit rates in rural residents continued at 60 and 90 days.Conclusion: Following hypoglycemic and hyperglycemic crises, when close follow-up is essential to prevent event recurrence, rural residents were less likely to see primary care or endocrinology clinicians than those in urban areas. Even in the urban population in our study, healthcare utilization was lower than expected considering the acuity of individuals. There is a clear opportunity to prioritize care following discharge and leverage population health tools, telehealth and team-based care, particularly in rural areas.
J. Herges: None. A.Z. Davis: None. D. Firkus: None. K.R. Neverman: None. K. Cole: None. R. McCoy: None.
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