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Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
REVIEW (Open Access)

Self-management of diabetes and associated comorbidities in rural and remote communities: a scoping review

Bodil Rasmussen A B C D J , Karen Wynter https://orcid.org/0000-0003-4620-7691 A B , Helen A. Rawson A E , Helen Skouteris F , Nicola Ivory G and Susan A. Brumby H I
+ Author Affiliations
- Author Affiliations

A Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia.

B Centre for Quality and Patient Safety Research – Western Health Partnership, Sunshine Hospital, 176 Furlong Road, St Albans, Vic. 3021, Australia.

C Department of Public Health, University of Copenhagen, Denmark.

D Faculty of Health Sciences, University of Southern Denmark, Denmark.

E Nursing and Midwifery, Monash University, 35 Rainforest Walk, Clayton, Vic. 3800, Australia.

F Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Vic. 3004, Australia.

G Deakin University School of Psychology, 1 Gheringhap Street, Geelong, Vic. 3220, Australia.

H School of Medicine, Deakin University, 75 Pigdons Road, Waurn Ponds, Vic. 3216, Australia.

I National Centre for Farmer Health, Western District Health Service, 20 Foster Street, Hamilton, Vic. 3300, Australia.

J Corresponding author. Email: bodil.rasmussen@deakin.edu.au

Australian Journal of Primary Health 27(4) 243-254 https://doi.org/10.1071/PY20110
Submitted: 6 May 2020  Accepted: 6 April 2021   Published: 7 July 2021

Journal Compilation © La Trobe University 2021 Open Access CC BY-NC-ND

Abstract

Chronic health conditions are more prevalent in rural and remote areas than in metropolitan areas; living in rural and remote areas may present particular barriers to the self-management of chronic conditions like diabetes and comorbidities. The aims of this review were to: (1) synthesise evidence examining the self-management of diabetes and comorbidities among adults living in rural and remote communities; and (2) describe barriers and enablers underpinning self-management reported in studies that met our inclusion criteria. A systematic search of English language papers was undertaken in PsycINFO, Medline Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, EMBASE and the Cochrane Database of Systematic Reviews, searching for literature indexed from the beginning of the database until 6 March 2020. Essential key concepts were diabetes, comorbidities, self-management and rural or remote. Twelve studies met the inclusion criteria. Six of these reported interventions to promote self-management for adults with diabetes in rural and remote communities and described comorbidities. These interventions had mixed results; only three demonstrated improvements in clinical outcomes or health behaviours. All three of these interventions specifically targeted adults living with diabetes and comorbidities in rural and remote areas; two used the same telehealth approach. Barriers to self-management included costs, transport problems and limited health service access. Interventions should take account of the specific challenges of managing both diabetes and comorbidities; telehealth may address some of the barriers associated with living in rural and remote areas.

Keywords: chronic health conditions, comorbidities, diabetes, rural and remote communities, self-management.


References

American Association of Diabetes Educators (2014) AADE7™ self-care behaviors: American Association of Diabetes Educators (AADE) position statement. Available at https://www.diabeteseducator.org/docs/default-source/legacy-docs/_resources/pdf/publications/aade7_position_statement_final.pdf?sfvrsn=4 [Verified 30 August 2019]

Arksey H, O’Malley L (2005) Scoping studies: towards a methodological framework. International Journal of Social Research Methodology 8, 19–32.
Scoping studies: towards a methodological framework.Crossref | GoogleScholarGoogle Scholar |

Australian Government (2018) Regional telecommunications review: getting it right out there. Available at https://www.communications.gov.au/publications/2018-regional-telecommunications-review-getting-it-right-out-there [Verified 31 January 2019]

Australian Institute of Health and Welfare (2015) The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2015. Available at https://www.aihw.gov.au/getmedia/584073f7-041e-4818-9419-39f5a060b1aa/18175.pdf.aspx?inline=true [Verified 8 March 2021]

Australian Institute of Health and Welfare (2016) Australia’s Health 2016: chronic disease and comorbidities. (Australian Government: AIHW, Canberra, ACT, Australia) Available at https://www.aihw.gov.au/getmedia/666de2ad-1c92-4db3-9c01-1368ba3c8c98/ah16-3-3-chronic-disease-comorbidities.pdf.aspx [Verified 30 August 2020]

Australian Institute of Health and Welfare (2017) Rural and remote health. Available at https://www.aihw.gov.au/reports/rural-health/rural-remote-health/contents/access-to-health-services [Verified 4 January 2018]

Australian Institute of Health and Welfare (2018) Australia’s Health 2018. Available at https://www.aihw.gov.au/getmedia/0c0bc98b-5e4d-4826-af7f-b300731fb447/aihw-aus-221-chapter-5-2.pdf.aspx [Verified 28 November 2018]

Australian Institute of Health and Welfare (2019) Diabetes. Available at https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/diabetes/overview [Verified 12 April 2019]

Bardach SH, Tarasenko YN, Schoenberg NE (2011) The role of social support in multiple morbidity: self-management among rural residents. Journal of Health Care for the Poor and Underserved 22, 756–771.
The role of social support in multiple morbidity: self-management among rural residents.Crossref | GoogleScholarGoogle Scholar | 21841277PubMed |

Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J (2002) Self-management approaches for people with chronic conditions: a review. Patient Education and Counseling 48, 177–187.
Self-management approaches for people with chronic conditions: a review.Crossref | GoogleScholarGoogle Scholar | 12401421PubMed |

Bell RA, Andrews JS, Arcury TA, Snively BM, Golden SL, Quandt SA (2010) Depressive symptoms and diabetes self-management among rural older adults. American Journal of Health Behavior 34, 36–44.
Depressive symptoms and diabetes self-management among rural older adults.Crossref | GoogleScholarGoogle Scholar | 19663750PubMed |

Beverly EA, Wray LA, Chiu CJ, Weinger K (2011) Perceived challenges and priorities in co-morbidity management of older patients with Type 2 diabetes. Diabetic Medicine 28, 781–784.
Perceived challenges and priorities in co-morbidity management of older patients with Type 2 diabetes.Crossref | GoogleScholarGoogle Scholar | 21395674PubMed |

Birabwa C, Bwambale MF, Waiswa P, Mayega RW (2019) Quality and barriers of outpatient diabetes care in rural health facilities in Uganda – a mixed methods study. BMC Health Services Research 19, 706
Quality and barriers of outpatient diabetes care in rural health facilities in Uganda – a mixed methods study.Crossref | GoogleScholarGoogle Scholar | 31619234PubMed |

Bodenheimer T, Lorig K, Holman H, Grumbach K (2002) Patient self-management of chronic disease in primary care. JAMA 288, 2469–2475.
Patient self-management of chronic disease in primary care.Crossref | GoogleScholarGoogle Scholar | 12435261PubMed |

Brown SA, García AA, Winter M, Silva L, Brown A, Hanis CL (2011) Integrating education, group support, and case management for diabetic Hispanics. Ethnicity & Disease 21, 20–26.

Carpenter R, Theeke L, Mallow J, Theeke E, Gilleland D (2017) Relationships among distress, appraisal, self-management behaviors, and psychosocial factors in a sample of rural Appalachian adults with type 2 diabetes. Online Journal of Rural Nursing and Health Care 17, 34–64.
Relationships among distress, appraisal, self-management behaviors, and psychosocial factors in a sample of rural Appalachian adults with type 2 diabetes.Crossref | GoogleScholarGoogle Scholar |

Chaturvedi SK, Manche Gowda S, Ahmed HU, Alosaimi FD, Andreone N, Bobrov A, Bulgari V, Carrà G, Castelnuovo G, de Girolamo G, Gondek T, Jovanovic N, Kamala T, Kiejna A, Lalic N, Lecic-Tosevski D, Minhas F, Mutiso V, Ndetei D, Rabbani G, Somruk S, Srikanta S, Taj R, Valentini U, Vukovic O, Wölwer W, Cimino L, Nouwen A, Lloyd C, Sartorius N (2019) More anxious than depressed: prevalence and correlates in a 15-nation study of anxiety disorders in people with type 2 diabetes mellitus. General Psychiatry 32, e100076
More anxious than depressed: prevalence and correlates in a 15-nation study of anxiety disorders in people with type 2 diabetes mellitus.Crossref | GoogleScholarGoogle Scholar | 31552386PubMed |

Ciemins E, Coon P, Peck R, Holloway B, Min S-J (2011) Using telehealth to provide diabetes care to patients in rural Montana: findings from the promoting realistic individual self-management program. Telemedicine Journal and e-Health 17, 596–602.
Using telehealth to provide diabetes care to patients in rural Montana: findings from the promoting realistic individual self-management program.Crossref | GoogleScholarGoogle Scholar | 21859347PubMed |

Colquhoun HL, Levac D, O’Brien KK, Straus S, Tricco AC, Perrier L, Kastner M, Moher D (2014) Scoping reviews: time for clarity in definition, methods, and reporting. Journal of Clinical Epidemiology 67, 1291–1294.
Scoping reviews: time for clarity in definition, methods, and reporting.Crossref | GoogleScholarGoogle Scholar | 25034198PubMed |

Corcoran KJ, Jowsey T, Leeder SR (2013) One size does not fit all: the different experiences of those with chronic heart failure, type 2 diabetes and chronic obstructive pulmonary disease. Australian Health Review 37, 19–25.
One size does not fit all: the different experiences of those with chronic heart failure, type 2 diabetes and chronic obstructive pulmonary disease.Crossref | GoogleScholarGoogle Scholar | 23158955PubMed |

Disler R, Glenister K, Wright J (2020) Rural chronic disease research patterns in the United Kingdom, United States, Canada, Australia and New Zealand: a systematic integrative review. BMC Public Health 20, 770
Rural chronic disease research patterns in the United Kingdom, United States, Canada, Australia and New Zealand: a systematic integrative review.Crossref | GoogleScholarGoogle Scholar | 32448173PubMed |

Glazier R, Moineddin R, Agha M, Zagorski B, Hall R, Manuel D, Sibley L, Kopp A (2008) The impact of not having a primary care physician among people with chronic conditions. Available at http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=32011000211 [Verified 22 November]

Grady PA, Gough LL (2015) Self-management: A comprehensive approach to management of chronic conditions. American Journal of Public Health 37, 187–194.

Grant JS, Steadman LA (2016) Barriers to diabetes self-management among rural individuals in the workplace. Workplace Health & Safety 64, 243–248.
Barriers to diabetes self-management among rural individuals in the workplace.Crossref | GoogleScholarGoogle Scholar |

Haynes A, Kalic R, Cooper M, Hewitt JK, Davis EA (2016) Increasing incidence of type 2 diabetes in Indigenous and non-Indigenous children in Western Australia, 1990–2012. The Medical Journal of Australia 204, 303
Increasing incidence of type 2 diabetes in Indigenous and non-Indigenous children in Western Australia, 1990–2012.Crossref | GoogleScholarGoogle Scholar | 27125801PubMed |

Iglay K, Hannachi H, Howie PJ, Xu J, Li X, Engel SS, Moore LM, Rajpathak S (2016) Prevalence and co-prevalence of comorbidities among patients with type 2 diabetes mellitus. Current Medical Research and Opinion 32, 1243–1252.
Prevalence and co-prevalence of comorbidities among patients with type 2 diabetes mellitus.Crossref | GoogleScholarGoogle Scholar | 26986190PubMed |

International Diabetes Federation (IDF) (2019) IDF Diabetes Atlas 9th Edition. (IDF: Brussels) Available at https://www.diabetesatlas.org/upload/resources/previous/files/8/IDF_DA_8e-EN-final.pdf [Verified 8 September 2020]

Jaglal SB, Haroun VA, Salbach NM, Hawker G, Voth J, Lou W, Kontos P, Cameron JE, Cockerill R, Bereket T (2013) Increasing access to chronic disease self-management programs in rural and remote communities using telehealth. Telemedicine Journal and e-Health 19, 467–473.
Increasing access to chronic disease self-management programs in rural and remote communities using telehealth.Crossref | GoogleScholarGoogle Scholar | 23570277PubMed |

Jeffrey B, Bagala M, Creighton A, Leavey T, Nicholls S, Wood C, Longman J, Barker J, Pit S (2019) Mobile phone applications and their use in the self-management of type 2 diabetes mellitus: a qualitative study among app users and non-app users. Diabetology & Metabolic Syndrome 11, 84
Mobile phone applications and their use in the self-management of type 2 diabetes mellitus: a qualitative study among app users and non-app users.Crossref | GoogleScholarGoogle Scholar |

Jeon Y-H, Essue B, Jan S, Wells R, Whitworth JA (2009) Economic hardship associated with managing chronic illness: a qualitative inquiry. BMC Health Services Research 9, 182
Economic hardship associated with managing chronic illness: a qualitative inquiry.Crossref | GoogleScholarGoogle Scholar | 19818128PubMed |

Jha D, Gupta P, Vamadevan SA, Jindal D, Perel P, Prieto-Merino D, Jacob P, Nyong J, Venugopal V, Singh K, Goenka S, Roy A, Tandon N, Patel V, Prabhakaran D (2017) Protocol for the mWellcare trial: a multicentre, cluster randomised, 12-month, controlled trial to compare the effectiveness of mWellcare, an mHealth system for an integrated management of patients with hypertension and diabetes, versus enhanced usual care in India. BMJ Open 7, e014851
Protocol for the mWellcare trial: a multicentre, cluster randomised, 12-month, controlled trial to compare the effectiveness of mWellcare, an mHealth system for an integrated management of patients with hypertension and diabetes, versus enhanced usual care in India.Crossref | GoogleScholarGoogle Scholar | 28801393PubMed |

Joanna Briggs Institute (2015) Methodology for JBI scoping reviews. Available at http://joannabriggs.org/assets/docs/sumari/Reviewers-Manual_Methodology-for-JBI-Scoping-Reviews_2015_v2.pdf [Verified 7 April 2019]

Jones L, Crabb S, Turnbull D, Oxlad M (2014) Barriers and facilitators to effective type 2 diabetes management in a rural context: a qualitative study with diabetic patients and health professionals. Journal of Health Psychology 19, 441–453.
Barriers and facilitators to effective type 2 diabetes management in a rural context: a qualitative study with diabetic patients and health professionals.Crossref | GoogleScholarGoogle Scholar | 23493867PubMed |

Jowsey T, Jeon Y-H, Dugdale P, Glasgow NJ, Kljakovic M, Usherwood T (2009) Challenges for co-morbid chronic illness care and policy in Australia: a qualitative study. Australia and New Zealand Health Policy 6, 22
Challenges for co-morbid chronic illness care and policy in Australia: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 19735576PubMed |

Kristensen MAT, Guassora AD, Arreskov AB, Waldorff FB, Hølge-Hazelton B (2018) ‘I’ve put diabetes completely on the shelf till the mental stuff is in place’. How patients with doctor-assessed impaired self-care perceive disease, self-care, and support from general practitioners. A qualitative study. Scandinavian Journal of Primary Health Care 36, 342–351.
‘I’ve put diabetes completely on the shelf till the mental stuff is in place’. How patients with doctor-assessed impaired self-care perceive disease, self-care, and support from general practitioners. A qualitative study.Crossref | GoogleScholarGoogle Scholar | 29929420PubMed |

Levac D, Colquhoun H, O’Brien KK (2010) Scoping studies: advancing the methodology. Implementation Science 5, 69
Scoping studies: advancing the methodology.Crossref | GoogleScholarGoogle Scholar | 20854677PubMed |

Lutes LD, Cummings DM, Littlewood K, Solar C, Carraway M, Kirian K, Patil S, Adams A, Ciszewski S, Hambidge B (2018) COMRADE: a randomized trial of an individually tailored integrated care intervention for uncontrolled type 2 diabetes with depression and/or distress in the rural southeastern US. Contemporary Clinical Trials 70, 8–14.
COMRADE: a randomized trial of an individually tailored integrated care intervention for uncontrolled type 2 diabetes with depression and/or distress in the rural southeastern US.Crossref | GoogleScholarGoogle Scholar | 29680319PubMed |

Magnan EM, Pandhi N, Smith MA, Palta M, Mahoney JE, Bolt DM, Fink J, Greenlee RT (2015) The relationship of individual comorbid chronic conditions to diabetes care quality. BMJ Open Diabetes Research and Care 3, e000080
The relationship of individual comorbid chronic conditions to diabetes care quality.Crossref | GoogleScholarGoogle Scholar | 26217492PubMed |

Mainous AG, King DE, Garr DR, Pearson WS (2004) Race, rural residence, and control of diabetes and hypertension. Annals of Family Medicine 2, 563–568.
Race, rural residence, and control of diabetes and hypertension.Crossref | GoogleScholarGoogle Scholar | 15576542PubMed |

McDermott RA, Tulip F, Schmidt B (2004) Diabetes care in remote northern Australian Indigenous communities. The Medical Journal of Australia 180, 512–516.
Diabetes care in remote northern Australian Indigenous communities.Crossref | GoogleScholarGoogle Scholar | 15139828PubMed |

McDermott RA, Schmidt B, Preece C, Owens V, Taylor S, Li M, Esterman A (2015) Community health workers improve diabetes care in remote Australian Indigenous communities: results of a pragmatic cluster randomized controlled trial. BMC Health Services Research 15, 68
Community health workers improve diabetes care in remote Australian Indigenous communities: results of a pragmatic cluster randomized controlled trial.Crossref | GoogleScholarGoogle Scholar | 25884300PubMed |

McLaren D, MacDermott S, Muir J (2014) On the road again: A farming family’s experience of the socioeconomic cost of travelling for health care. In ‘Sowing the seeds of farmers’ health’. (Eds S Brumby, A Kennedy, B Todd) pp. 103–121. (VURRN Press: Maryborough, Vic., Australia)

Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ (Clinical Research Ed.) 339, b2535

Moulton CD, Pickup JC, Ismail K (2015) The link between depression and diabetes: the search for shared mechanisms. The Lancet. Diabetes & Endocrinology 3, 461–471.
The link between depression and diabetes: the search for shared mechanisms.Crossref | GoogleScholarGoogle Scholar |

Naik AD, White CD, Robertson SM, Armento MEA, Lawrence B, Stelljes LA, Cully JA (2012) Behavioral health coaching for rural-living older adults with diabetes and depression: an open pilot of the HOPE Study. BMC Geriatrics 12, 37
Behavioral health coaching for rural-living older adults with diabetes and depression: an open pilot of the HOPE Study.Crossref | GoogleScholarGoogle Scholar | 22828177PubMed |

Naik AD, Hundt NE, Vaughan EM, Petersen NJ, Zeno D, Kunik ME, Cully JA (2019) Effect of telephone-delivered collaborative goal setting and behavioral activation vs enhanced usual care for depression among adults with uncontrolled diabetes: a randomized clinical trial. JAMA Network Open 2, e198634
Effect of telephone-delivered collaborative goal setting and behavioral activation vs enhanced usual care for depression among adults with uncontrolled diabetes: a randomized clinical trial.Crossref | GoogleScholarGoogle Scholar | 31509203PubMed |

National Rural Health Alliance (2011) Demography. Available at https://www.ruralhealth.org.au/book/demography#:~:text=Approximately%2035%25%20of%20Australia’s%20Indigenous,in%20regional%20or%20remote%20areas [Verified 8 March 2021]

O’Connor A, Wellenius G (2012) Rural-urban disparities in the prevalence of diabetes and coronary heart disease. Public Health 126, 813–820.
Rural-urban disparities in the prevalence of diabetes and coronary heart disease.Crossref | GoogleScholarGoogle Scholar | 22922043PubMed |

Ording AG, Sørensen HT (2013) Concepts of comorbidities, multiple morbidities, complications, and their clinical epidemiologic analogs. Clinical Epidemiology 5, 199–203.
Concepts of comorbidities, multiple morbidities, complications, and their clinical epidemiologic analogs.Crossref | GoogleScholarGoogle Scholar | 23861599PubMed |

Pambianco G, Costacou T, Orchard TJ, Ellis D, Becker DJ, Klein R (2006) The 30-year natural history of type 1 diabetes complications: the Pittsburgh Epidemiology of Diabetes Complications Study experience. Diabetes 55, 1463–1469.
The 30-year natural history of type 1 diabetes complications: the Pittsburgh Epidemiology of Diabetes Complications Study experience.Crossref | GoogleScholarGoogle Scholar | 16644706PubMed |

Piette JD, Kerr EA (2006) The impact of comorbid chronic conditions on diabetes care. Diabetes Care 29, 725–731.
The impact of comorbid chronic conditions on diabetes care.Crossref | GoogleScholarGoogle Scholar | 16505540PubMed |

Roy T, Lloyd CE (2012) Epidemiology of depression and diabetes: A systematic review. Journal of Affective Disorders 142, S8–S21.
Epidemiology of depression and diabetes: A systematic review.Crossref | GoogleScholarGoogle Scholar | 23062861PubMed |

Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, Colagiuri S, Guariguata L, Motala AA, Ogurtsova K, Shaw JE, Bright D, Williams R (2019) Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9(th) edition. Diabetes Research and Clinical Practice 157, 107843
Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9(th) edition.Crossref | GoogleScholarGoogle Scholar | 31518658PubMed |

Schoenberg NE, Bardach SH, Manchikanti KN, Goodenow AC (2011) Appalachian residents’ experiences with and management of multiple morbidity. Qualitative Health Research 21, 601–611.
Appalachian residents’ experiences with and management of multiple morbidity.Crossref | GoogleScholarGoogle Scholar | 21263063PubMed |

Shea S, Weinstock RS, Teresi JA, Palmas W, Starren J, Cimino JJ, Lai AM, Field L, Morin PC, Goland R, Izquierdo RE, Ebner S, Silver S, Petkova EVA, Kong J, Eimicke JP (2009) A randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus: 5 year results of the IDEATe1 Study. Journal of the American Medical Informatics Association : JAMIA 16, 446–456.
A randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus: 5 year results of the IDEATe1 Study.Crossref | GoogleScholarGoogle Scholar | 19390093PubMed |

Si D, Bailie R, Cunningham J, Robinson G, Dowden M, Stewart A, Connors C, Weeramanthri T (2008) Describing and analysing primary health care system support for chronic illness care in Indigenous communities in Australia’s Northern Territory – use of the Chronic Care Model. BMC Health Services Research 8, 112
Describing and analysing primary health care system support for chronic illness care in Indigenous communities in Australia’s Northern Territory – use of the Chronic Care Model.Crossref | GoogleScholarGoogle Scholar | 18505591PubMed |

Smith KJ, Béland M, Clyde M, Gariépy G, Pagé V, Badawi G, Rabasa-Lhoret R, Schmitz N (2013) Association of diabetes with anxiety: a systematic review and meta-analysis. Journal of Psychosomatic Research 74, 89–99.
Association of diabetes with anxiety: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 23332522PubMed |

Stuckey M, Read E, Shoemaker K, Russell-Minda E, Petrella R, Munoz C, Kleinstiver P (2011) Diabetes and Technology for Increased Activity (DaTA) study: results of a remote monitoring intervention for prevention of metabolic syndrome. Journal of Diabetes Science and Technology 5, 928–935.
Diabetes and Technology for Increased Activity (DaTA) study: results of a remote monitoring intervention for prevention of metabolic syndrome.Crossref | GoogleScholarGoogle Scholar | 21880236PubMed |

Teljeur C, Smith SM, Paul G, Kelly A, O’Dowd T (2013) Multimorbidity in a cohort of patients with type 2 diabetes. The European Journal of General Practice 19, 17–22.
Multimorbidity in a cohort of patients with type 2 diabetes.Crossref | GoogleScholarGoogle Scholar | 23432037PubMed |

Utz SW, Steeves RH, Wenzel J, Hinton I, Jones RA, Andrews D, Muphy A, Oliver MN (2006) “Working hard with it”: self-management of type 2 diabetes by rural African Americans. Family & Community Health 29, 195–205.
“Working hard with it”: self-management of type 2 diabetes by rural African Americans.Crossref | GoogleScholarGoogle Scholar |

Utz SW, Williams IC, Jones R, Hinton I, Alexander G, Yan G, Moore C, Blankenship J, Steeves R, Norman Oliver M (2008) Culturally tailored intervention for rural African Americans with Type 2 diabetes. The Diabetes Educator 34, 854–865.
Culturally tailored intervention for rural African Americans with Type 2 diabetes.Crossref | GoogleScholarGoogle Scholar | 18832290PubMed |

Vanderlee L, Ahmed S, Ferdous F, Farzana FD, das SK, Ahmed T, Hammond D, Faruque ASG (2016) Self-care practices and barriers to compliance among patients with diabetes in a community in rural Bangladesh. International Journal of Diabetes in Developing Countries 36, 320–326.
Self-care practices and barriers to compliance among patients with diabetes in a community in rural Bangladesh.Crossref | GoogleScholarGoogle Scholar |

World Health Organization (2018) Global health estimates 2016: deaths by cause, age, sex, by country and by region, 2000–2016. (World Health Organization: Geneva) Available at https://www.who.int/healthinfo/global_burden_disease/estimates/en/ [Verified 12 April 2020]

Yerrapragada DB, Rao CR, Karunakaran K, Lee HSE (2019) Cognitive dysfunction among adults with type 2 diabetes mellitus in Karnataka, India. The Ochsner Journal 19, 227–234.
Cognitive dysfunction among adults with type 2 diabetes mellitus in Karnataka, India.Crossref | GoogleScholarGoogle Scholar | 31528133PubMed |