OBJECTIVES AND METHOD: To compare rural and urban family physicians' compliance with the Canadian Diabetes Association (CDA) guidelines for the care of patients with non-insulin-dependent diabetes mellitus (NIDDM). To compare blood sugar control levels in patients with NIDDM being cared for by rural or urban family physicians, using levels of glycosylated hemoglobin (HbA1C) as a surrogate measure of glycemic control.A retrospective medical chart audit was undertaken. With standardized forms based on the CDA guidelines, information about blood sugar and lipid level control, presence of diabetes complications and physician management parameters was extracted from the medical charts of 118 patients with NIDDM in 6 rural and 4 urban family physicians' offices in Newfoundland. Seventy patients were from rural practices and 48 were from urban practices. Fifty-five patients were male, 63 were female and the mean age of the sample population was 64 years.Main outcome measures: Family physician compliance with 9 procedures recommended by the CDA guidelines and glycosylated hemoglobin (HbA1C) levels.RESULTS: Compliance with CDA guidelines was in general somewhat low (mean 5.72 out of 9), compliance of rural physicians (mean = 5.36) was less than that of urban physicians (mean = 6.25). Patients of rural physicians appeared to have a similar degree of diabetes control when compared to patients of urban physicians (mean HbA1C: rural = 0.079, urban = 0.081), despite having fewer physician interventions, laboratory tests and referrals to dietitians. Fewer rural patients than urban patients used home monitors and fewer were taking insulin. Despite the poor compliance with guidelines, 87% of patients who had their HbA1C checked had levels in the optimal or acceptable range.CONCLUSIONS: CDA compliance in a sample of 10 family physician practices was poor, with rural practices being less compliant than urban ones. Using HbA1C as a surrogate outcome measure of patient diabetes control, rural and urban physicians seemed to be doing equally well, despite fewer interventions by rural physicians. However, these results should be interpreted with caution, as this patient sample was small and HbA1C measurement was recorded in only about 50% of the patients. Further research into the possible differences in the care given to rural versus urban patients with NIDDM is suggested.