The relationship between literacy and glycemic control in a diabetes disease-management program.
This study examined the role of literacy in patients with poorly controlled diabetes who were participating in a diabetes management program that included low-literacy-oriented interventions.



A before-after analysis was performed of a pharmacist-led diabetes management program for 159 patients with type 2 diabetes and poor glycemic control (hemoglobin A1c [A1C] > or = 8.0%). Clinic-based pharmacists offered one-to-one education and medication management for these patients using techniques that did not require high literacy. Literacy was measured by the Rapid Estimate of Adult Literacy in Medicine (REALM) test and dichotomized at the 6th-grade level. The A1C values were collected prior to enrollment, at enrollment, and approximately 6 months after enrollment.



Of the 111 patients with follow-up data, 55% had literacy levels at the 6th-grade level or below. Lower literacy was more common among African Americans, older patients, and patients who required medication assistance. There was no significant relationship between literacy status and A1C prior to enrollment or at enrollment. Over the 6-month study period, patients with low and high literacy had similar improvements in A1C.



This diabetes care program, which used individualized teaching with low-literacy techniques, significantly improved A1C values independent of literacy status.
Rothman
Russell
R
Vanderbilt Center for Health Services Research, Vanderbilt University, Nashville, Tennessee
Malone
Robb
R
Department of Medicine University of North Carolina, Chapel Hill
Bryant
Betsy
B
Department of Medicine University of North Carolina, Chapel Hill
Horlen
Cheryl
C
School of Pharmacy, Campbell University, Buies Creek, North Carolina
DeWalt
Darren
D
Department of Medicine University of North Carolina, Chapel Hill
Pignone
Michael
M
Department of Medicine, Cecil G. Sheps Center for Health Services Research University of North Carolina, Chapel Hill
D000367:Age Factors; D015190:Blood Glucose Self-Monitoring; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism / Q000517:prevention & control*; D019468:Disease Management; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008489:Medical Indigency; D008875:Middle Aged; D009657:North Carolina; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic / Q000458:organization & administration*; D010595:Pharmacists / Q000458:organization & administration*; D015397:Program Evaluation; D012648:Self Care / Q000379:methods; D013664:Teaching Materials / Q000592:standards
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin