Diabetes Care Disparities: The Impact of Lifestyle, Medication Access, and Medical Conditions on Glycemic Control in Rural and Urban Settings

Background: Optimal glycemic control in Type 2 diabetes remains a critical public health challenge. This study was aimed at elucidating the sociodemographic, lifestyle, and clinical factors associated with poor glycemic control among Iranian patients. Materials and Methods: A cross‐sectional study was conducted on 546 patients with Type 2 diabetes at Imam Hossein Hospital, Tehran, from July 2023 to December 2024. Participants were categorized into good (HbA1c < 7 % ) and poor (HbA1c ≥ 7 % ) glycemic control groups. Data were collected using structured checklists and validated tools. Missing data were handled with multiple imputation, and logistic regression identified predictors of glycemic control. Results: Rural residence significantly increased the odds of poor glycemic control (OR = 3.04, 95% CI: 1.98–4.65). Limited medication access was a major determinant; participants reporting “rarely” or “sometimes” having access to prescribed medications had markedly higher risks (OR = 5.16, 95% CI: 2.41–11.06, and OR = 3.75, 95% CI: 2.20–6.40, respectively). Engaging in moderate and high physical activity (based on metabolic equivalent) was protective (OR = 0.49 and OR = 0.40, respectively). Additionally, each extra day per week of fatty food consumption increased the odds of poor control by 26% (OR = 1.26, 95% CI: 1.09–1.46). A 10 mg/dL increase in HDL cholesterol reduced risk (OR = 0.86, 95% CI: 0.75–0.98, p = 0.04), while longer durations of oral medication use were associated with a modest risk increase (OR = 1.05, 95% CI: 1.01–1.10, p = 0.02). Conclusions: These findings underscore the significance of geographic disparities, medication access, lifestyle practices, and dietary behaviors in diabetes management. Targeted interventions tailored to these factors are essential to improve glycemic outcomes in Type 2 diabetes.