JMIR Publications

ABSTRACT

Background:

Rural patients with diabetes have difficulty accessing care and are at higher risk for poor diabetes management. Sustained use of patient portal features like secure messaging (SM) can provide accessible support for diabetes self-management.

Objective:

The current study explored whether rural patients’ self-management and glycemic control was associated with use of SM.

Methods:

This secondary cross-sectional analysis of 448 veterans with diabetes used stratified random sampling to recruit a diverse sample from the United States (rural vs. urban and good vs. poor glycemic control). Administrative, survey, interview, and clinical data were used to determine patients’ rurality, use of SM, diabetes self-management behaviors, and glycemic control. Moderated mediation analyses assessed these relationships.

Results:

The sample was 51% rural (n = 229) and 49% urban (n = 219). Mean age was 66.4 years (SD = 7.7). More frequent SM use was associated with better diabetes self-management (P = .007), which was associated with better glycemic control (P < .001). Among rural patients, SM use was indirectly associated with better glycemic control through improved diabetes self-management (95% CI [0.004, 0.927]). These effects were not observed among urban veterans with diabetes (95% CI [-1.039, 0.056]). Rural patients were significantly more likely than urban patients to have diabetes-related content in their secure messages (P=.012).

Conclusions:

More frequent SM use is associated with engaging in diabetes self-management, which, in turn, is associated with better diabetes control. Among rural patients with diabetes, use of SM is indirectly associated with better diabetes control. Frequent patient-team communication through SM about diabetes-related content may help rural patients with diabetes self-management, resulting in better glycemic control.