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Willis, Ruth

Nursing

2012

MS

This thesis explored the association of the presence or absence of sidewalks and physiologic control of blood glucose among adults with diabetes in a rural state. The association of walk-related infrastructure in metropolitan areas, walking behavior and prevalence of weight-related chronic illness are well documented. Little is known, however, about these factors in rural settings. Evidence exists that rural patients with chronic conditions such as diabetes face a greater number of barriers to disease management than similar patients in metropolitan areas. In this study, the lack of sidewalks was used as a proxy of rural land use patterns. A secondary data analysis of interview data from a cluster-randomized trial of the Vermont Diabetes Information System was performed to determine if there was an association between physiologic control of diabetes and the built environment as represented by sidewalks. The outcome measure was hemoglobin Alc (HgbAlc).
Responses to interview questions of 775 adults with diabetes were compared to measured HgbAlc values. No significant association was found after adjusting for social and demographic characteristics, medication use, and dutation of diabetes between patients reporting sidewalks in front of their homes and HgbA1c. These findings suggest that the presence or absence of a sidewalk is not associated with hemoglobin A1c in a cross-sectional study of older adults with diabetes under relatively good glycemic control. Further studies to examine other features ofthe rural environment are needed as these results do not explain differences in diabetes control as reported in the literature.