https://diabetes.acponline.org/archives/2015/03/13/2.htm

Low health literacy linked to misperceptions of glucose control

Diabetic patients with low health literacy and persistently elevated HbA1c levels were more likely to have the erroneous impression that their glucose was well controlled, according to a recent study.


Diabetic patients with low health literacy and persistently elevated HbA1c levels were more likely to have the erroneous impression that their glucose was well controlled, according to a recent study.

Researchers performed a cross-sectional analysis of baseline data from a randomized, controlled trial involving patients with type 2 diabetes and persistently poor diabetes control, defined as 2 previous HbA1c measurements above 8.0%. Perceived glucose control and other possibly related factors, including health literacy, were determined during an in-person interview, including the question “How well do you think you are managing to control your diabetes?” The responses ranged from 1 (not very well) to 5 (very well) on a 5-point Likert scale. Health literacy was measured with the Rapid Estimate of Adult Literacy (REALM), a validated health word recognition test with scores from 0 to 66, where lower scores indicate lower reading levels. The study results were published online Feb. 19 by Diabetes Educator.

A total of 280 patients from 6 primary care practices and 1 diabetes clinic, all in Philadelphia, were included in the study. Patients were enrolled between April 2011 and February 2013, were 30 to 70 years of age, and spoke English. Eighty-three percent of patients were African-American, and 70% were women. Twelve percent of patients had a REALM score indicating a reading level of sixth grade or below, 23% had a REALM score indicating a reading level of seventh to eighth grade, and 64% had a REALM score indicating a reading level of high school or above. Thirty-nine percent of patients reported that they were controlling their diabetes well or very well. This percentage was higher in patients with a health literacy level of seventh to eighth grade and those with a health literacy level of sixth grade and below (57% and 61%, respectively) and lower in patients with a health literacy level of high school and above (29%).

The authors noted that their study does not prove causation and that their results may not be generalizable, among other limitations. However, they concluded that people with low health literacy and poorly controlled diabetes are more likely to erroneously think they have their diabetes under control and may be less likely to make changes to improve control of their disease. As a result, they said, clinicians should take health literacy into account when discussing diabetes control and setting goals with patients.

The authors pointed out that screening for low health literacy could upset or alienate patients and recommended a “universal precautions” approach that would provide education materials to all patients regardless of literacy level. They also said that according to their findings, patients rely more on nonclinical cues like self-management behaviors to measure disease control than on clinical measures such as HbA1c. “Providers and diabetes educators must be aware of their patients' understanding of control as well as the cues that they use to determine control to educate and motivate them to make the changes necessary to improve disease management,” the authors wrote.