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Disparities Research

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Poor health literacy may contribute to excess diabetes-related complications among disadvantaged groups

People with type 2 diabetes are often called upon to self-manage their chronic disease. They must interpret blood sugar values to monitor blood glucose, manage multiple medications, visit several providers, maintain foot hygiene (due to poor sensation and circulation), adhere to diet and meal plans, and exercise. Patients who have problems reading materials such as prescription bottles, educational brochures, and nutrition labels are more likely than patients with diabetes who are more literate to have poor blood-sugar control and higher rates of diabetes-related complications, according to a study supported by the Agency for Healthcare Research and Quality (HS10856).

Strategies are needed to enhance communication with disadvantaged diabetes patients, who often are poorly educated, immigrants, elderly, or members of minority groups. Poor health literacy may contribute to the greater burden of diabetes-related complications seen among these patients, suggest the researchers who conducted the study. They used the short-form Test of Functional Health Literacy in Adults (TOFHLA) in English and Spanish to assess the health literacy of 408 patients from two public-hospital-affiliated primary care clinics who had type 2 (adult-onset) diabetes. They compared the TOFHLA scores with clinical data and the presence of self-reported diabetes complications, such as retinopathy (eye disease).

After adjusting for other socioeconomic and clinical factors affecting glycemic control, patients with inadequate health literacy had nearly one-half the odds of patients with adequate health literacy of achieving tight glycemic control (hemoglobin HbA1c of 7.2 percent or less) and a two-fold greater odds of having poor glycemic control (HbA1c of 9.5 percent or more) and to report having retinopathy. A similar association between health literacy and other self-reported diabetes complications did not reach statistical significance.

More details are in "Association of health literacy with diabetes outcomes," by Dean Schillinger, M.D., Kevin Grumbach, M.D., John Piette, Ph.D., and others, in the July 24, 2002 Journal of the American Medical Association 288(4), pp. 475-482.

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