Original Article Diabetes risk factors, diabetes and diabetes care in a rural Australian community David Simmons, 1,2 Lisa Bourke, 3 Edward Yau 4 and Mary Hoodless 5 1 Department of Diabetes, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; 2 Department of Rural Health, 3 School of Rural Health, University of Melbourne, Shepparton, 5 Upper Murray Health and Community Services, Corryong, Victoria, Australia; and 4 Waikato Clinical School, University of Auckland, Hamilton, New Zealand Abstract Objective: To comprehensively describe diabetes- related risk factors, quality of care and patient-perceived barriers to care in a rural community. Design: Cross-sectional mail study, self-completed survey and retrospective chart review. Setting: Community and health services in Corryong, rural Victoria, Australia. Participants: Ninety-seven patients with diabetes and 495 with other diseases in the mail study, 84 with dia- betes in the self-completed survey and 101 diabetic patient chart reviews. Main outcome measures: Self-reported lifestyle activi- ties, uptake of health checks, metabolic measures and uptake of medication, and self-reported barriers to diabetes care. Results: Most residents without diabetes had recently had their blood pressure and cholesterol checked; 60.4% were trying to control their weight and 73.9% were exercising regularly (although only 30.7% to an adequate level). Those with diabetes reported a greater uptake of healthy living messages, and had a mean HbA1c of 7.3%, total cholesterol of 5.0 mmol L -1 ; 12.9% had a diastolic blood pressure 85 mmHg. Foot checks were infrequent (18%). There was substantial room to increase antiplatelet, blood pressure, antihyper- glycaemia and lipid-lowering therapy. Most patients reported psychological (84.5%) and educational (82.1%) barriers to care, with few perceiving physical barriers to care. Conclusion: Living in a rural area with predominantly GP care can be associated with comparatively good metabolic control, although psycho-educational barriers are frequently present. In the wider community, risk factors for diabetes remain common, and the majority have been screened for components of the metabolic syndrome in the previous year. KEY WORDS: diabetes mellitus, educational barrier, psychological barrier, risk factor, self-management. Introduction Diabetes mellitus is a growing problem in Australia. 1 In Australia, as elsewhere, 2 uptake of advances in diabetes care 3 is patchy, 4 although the reasons for this remain unclear. Hiss described many barriers to quality type 2 diabetes care from a health service and clinical perspec- tive, 5 one of which was ‘generating behaviour change’ among patients. The importance of individuals making their own decisions (i.e. self-management) is now rec- ognised as a further important aspect of chronic disease management resulting in improved quality of care and clinical outcomes. 6 Substantial psychosocial and other barriers to self-care often exist to confound the impact of modern care. 7,8 Such personal barriers to diabetes care have now been categorised comprehensively 8 and are associated with uptake of self-care practices, such as self-monitoring of blood glucose. 9 We now describe an integrated approach to describing diabetes care and barriers to its implementation, includ- ing personal barriers, in a rural community in Victoria with very little access to specialist care. This mixed- method approach might be of use for other communities due to its comprehensiveness and ability to describe care, identify care needs and identify barriers to care. Methods The study area and its services Corryong and environs includes approximately 2800 people, 123 km from the regional centre. Older people, Correspondence: Dr David Simmons, Department of Diabetes, Addenbrooke’s Hospital, Box 49, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 2QQ, UK. Email: dsworkster@gmail.com Accepted for publication 29 April 2007. Aust. J. Rural Health (2007) 15, 296–303 © 2007 The Authors Journal Compilation © 2007 National Rural Health Alliance Inc. doi: 10.1111/j.1440-1584.2007.00903.x