Introduction and Objective: Rural populations experience higher diabetes burden and barriers to care. RDMPs may mitigate geographic barriers; however, evidence comparing rural and urban populations remains limited. The objective of this study was to evaluate whether enrollment (ENR), engagement (ENG), and glycemic outcomes among rural participants in an RDMP were non-inferior to urban participants.Methods: We conducted a cross-sectional analysis of members eligible for the Teladoc RDMP through December 31, 2024. Rural-urban status was assigned using primary Rural-Urban Commuting Area (RUCA) codes based on ZIP code. ENR rate was defined among eligible members as active participation during the last 90 days of 2024. ENG rate was the proportion of enrolled members demonstrating active program use. Non-inferiority (NI) between urban and rural groups was assessed for enrollment and engagement using a predefined relative percent difference margin of 10% with a Chi-square test. Estimated A1c (eA1c) reduction calculated via Nathan’s method used first and last measurements. Ordinary least squares were used to adjust differences in eA1c reduction between groups and evaluated using a NI of 0.3% A1c.Results: Eligible individuals enrolled in the RDMP (n=382,307) were female (51.0%), mean age 61.2 years (SD 18.3), 15% of recruitables and enrolled populations resided in rural communities. ENR rates were identical between urban and rural populations (14.9% in each group; p < 0.01). ENG rates were high in both groups (96.1% urban vs. 95.2% rural), meeting NI threshold (p < 0. 01). Adjusted reductions in eA1c were comparable between urban and rural participants (1.5% vs. 1.4%, respectively), with rural outcomes meeting NI threshold (p < 0. 01).Conclusion: Findings indicate that rural participants of a RDMP have similar engagement and clinical outcomes compared to urban participants, suggesting RDMPs may help address geographic disparities in diabetes care.
R.A. James: Employee; Current; Teladoc Health. Stock/Shareholder; Current; Teladoc Health. H. Johnson: Employee; Current; Teladoc Health. J. Lin: None. M. Hong: None. C. Singleton: Employee; Current; Teladoc Health.
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