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The context of rural communities underscores the importance of tailored approaches to mitigate rural health inequities and promote the well-being of rural residents. The aim of this study was to evaluate the temporal pattern of amputations in patients with type 2 diabetes mellitus (T2DM), the risk of amputations by new and older anti-diabetic drugs (ADDs), and the interplay of peripheral artery disease (PAD) with therapy and amputation risk. Using Centricity Electronic Medical Records from USA, 3293983 patients with T2DM were identified