Observational studyBMJ open2022
Variation in appropriate diabetes care and treatment targets in urban and rural areas in England: an observational study of the 'rule of halves'.
Observational study in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 2 of them syntheses that pooled it.
What it found
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The trial behind it
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Who cites it
6 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- COVID-19's disruptions to cancer care pathways and widening of health inequalities in the UK: a systematic review.BMC health services research · 2026Pooled it
- Inclusion of Rurality and Social Determinants of Health in Documents for the Primary Prevention of Type 2 Diabetes: A Systematic Review.Metabolic syndrome and related disorders · 2024Pooled it
- Pre-pandemic diabetes and risk of long COVID: longitudinal evidence.Journal of diabetes and metabolic disorders · 2025Article
- Diabetes care for people experiencing homelessness in the UK: insights from a national survey of frontline professionals and the development of an integrated care model.Frontiers in public health · 2025Article
- Rural-urban disparities in the diagnosis and treatment of hypertension and diabetes among aging Indians.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2024Article
- Is the "Rule of Halves" Applicable for Diabetes Mellitus? A Cross-Sectional Study in a Coastal Area of Karnataka, India.Indian journal of community medicine : official publication of Indian Association of Preventive & Social MedicineArticle
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo estimate the 'rule of halves' for diabetes care for urban and rural areas in England using several data sources covering the period 2015-2017; and to examine the extent to which any differences in urban and rural settings are explained by population characteristics and the workforce supply of primary care providers (general practices).
designA retrospective observational study.
settingPopulations resident in predominantly urban and rural areas in England (2015-2017).
participantsN=33 336 respondents to the UK Household Longitudinal Survey in urban and rural settings in England; N=4913 general practices in England reporting to the National Diabetes Audit and providing workforce data to NHS Digital. OUTCOMES: Diabetes prevalence; administrative records of diagnoses of diabetes; provision of (all eight) recommended diabetes care processes; diabetes treatment targets.
resultsDiabetes prevalence was higher in urban areas in England (7.80% (95% CI 7.30% to 8.31%)) relative to rural areas (7.24% (95% CI 6.32% to 8.16%)). For practices in urban areas, relatively fewer cases of diabetes were recorded in administrative medical records (69.55% vs 71.86%), and a smaller percentage of those registered received the appropriate care (45.85% vs 49.32%). Among estimated prevalent cases of diabetes, urban areas have a 24.84% achieving these targets compared with 25.16% in rural areas. However, adjusted analyses showed that the performance of practices in urban areas in providing appropriate care quality was not significantly different from practices in rural areas.
conclusionsThe 'rule of halves' is not an accurate description of the actual pattern across the diabetes care pathway in England. More than half of the estimated urban and rural diabetes population are registered with clinical practices and have access to treatment. However, less than half of those registered for treatment have achieved treatment targets. Appropriate care quality was associated with a greater proportion of patients with diabetes achieving treatment targets.
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