Correlates of Glycemic Status Among American Indian Adults With Type 2 Diabetes in Rural Southeastern Oklahoma.

Patients missing 2020 or 2021 HbA1c data were excluded, so the sample may not represent all adults with type 2 diabetes in the health system. Medicaid status was used as a proxy for socioeconomic status, and Oklahoma Medicaid expansion had only just begun, so some eligible patients may not have been enrolled. Driving distance was estimated from the geographic center of each patient's zip code, not the home address. The study did not include body mass index or other adiposity measures, and it did not exclude conditions or medications that can affect HbA1c, such as pregnancy or anemia. Data were collected during the COVID-19 pandemic, so visit patterns may have been atypical. The study included patients from one rural Tribal health system, so results may not apply to other Tribal nations or health care settings. The analysis did not include Indigenous frameworks of social determinants of health or community-determined factors.

The senior author has a longstanding research relationship with the Choctaw Nation of Oklahoma.

Do not read the lower HbA1c among patients with no visits as proof that fewer visits are better. This was an observational study, so the association does not show that reducing visits would lower HbA1c.