RE:

Positive Review Points:

1. The study benefits from a large cohort of 45,279 patients, enhancing the statistical power and reliability of the findings. The retrospective cohort design allows for the examination of factors associated with the quality of diabetes care over a substantial timeframe, providing a comprehensive understanding of rural-urban disparities.

2. The use of the D5 metric, with its well-defined components related to diabetes care, provides a clear and standardized measure for assessing the quality of care. This approach facilitates comparability across rural and urban settings, aiding in the identification of specific areas where improvements may be needed.

3. The inclusion of various covariates such as age, sex, race, and adjusted clinical group (ACG) score strengthens the study's ability to control for potential confounding factors. Additionally, the acknowledgment of patients being part of the same integrated health system ensures a more accurate comparison between rural and urban groups, minimizing systemic variations.

Negative Review Points:

1. While the study identifies rural-urban disparities in diabetes care quality, it lacks a detailed exploration of specific challenges faced by rural patients. Understanding the unique barriers in rural settings could provide more targeted insights and inform interventions tailored to address the specific needs of these populations.

2. The study reports an association between having an endocrinology visit and a lower likelihood of meeting the D5 metric. However, the study does not establish causation, and a more in-depth analysis of the reasons behind this association is necessary to inform actionable strategies for improvement.

3.The study includes covariates such as age, sex, and race but does not explicitly mention socioeconomic factors, which could play a significant role in diabetes care outcomes. A more comprehensive examination of socioeconomic determinants might enhance the understanding of disparities and guide targeted interventions.