1086-P: Rural Residence Is Associated with a Lower Likelihood of Dipeptidyl Peptidase 4 Inhibitor Use for Treatment Intensification

Introduction: Several drug therapy management strategies exist when treatment intensification is required in type 2 diabetes, however, an understudied factor influencing drug therapy choice is an individual's location of residence along the rural-urban continuum. The objective of our study was to explore the association between location of residence (rural, urban, metropolitan) and the use of dipeptidyl peptidase 4 inhibitors (DPP-4i) for first treatment intensification of type 2 diabetes. Methods: We conducted a retrospective cohort study from 2008 to 2019 using administrative data from Alberta, Canada. Cohort entry was established when an individual became a new metformin user and at this time, location of residence was defined using postal codes. Individuals were followed until a dispensation for treatment intensification occurred (classified as DPP-4i or non-DPP-4i-based therapy). A multivariable logistic regression analysis was performed to determine the association between location of residence and likelihood of DPP-4i dispensation, adjusting for clinically relevant confounders. Results: Of 66,064 new metformin users experiencing treatment intensification, 15,467 (23%) were intensified with a DPP-4i. At the beginning of the observation period, proportion of DPP-4i dispensations were similar (7% metropolitan, 6% urban, 5% rural). However, over time a maximum 10% difference was noted between rural and metropolitan/urban (32% metropolitan, 27% urban, 22% rural). After adjusting for potential confounders, we determined that rural-dwellers are 36% less likely to have a DPP-4i dispensed, compared to metropolitan (aOR:0.64;95%CI:0.61-0.67) and over time, uptake in rural areas is slower. Conclusion: Our study sheds light on the impact of location of residence on drug therapy management in type 2 diabetes. The differential management experienced by rural-dwellers demonstrates a substantial gap in health equality across our jurisdiction.