title: Diabetes numeracy: an overlooked factor in understanding racial disparities in glycemic control.
abstract: OBJECTIVE
  Understanding the reasons and eliminating the pervasive health disparities in diabetes is a major research, clinical, and health policy goal. We examined whether health literacy, general numeracy, and diabetes-related numeracy explain the association between African American race and poor glycemic control (A1C) in patients with diabetes.
  
  
  METHODS
  Adults with type 2 diabetes (n = 383) were enrolled in a cross-sectional study at primary care and diabetes clinics at three medical centers. Data collected included the following: self-reported race, health literacy, general numeracy, diabetes-related numeracy, A1C, and sociodemographic factors. A series of structural equation models were estimated to explore the interrelations between variables and test for mediation.
  
  
  RESULTS
  In model 1, younger age (r = -0.21, P < 0.001), insulin use (r = 0.27, P < 0.001), greater years with diabetes (r = 0.16, P < 0.01), and African American race (r = 0.12, P < 0.01) were all associated with poorer glycemic control. In model 2, diabetes-related numeracy emerged as a strong predictor of A1C (r = -0.46, P < 0.001), reducing the association between African American and poor glycemic control to nonsignificance (r = 0.10, NS). In model 3, African American race and older age were associated with lower diabetes-related numeracy; younger age, insulin use, more years with diabetes, and lower diabetes-related numeracy were associated with poor glycemic control.
  
  
  CONCLUSIONS
  Diabetes-related numeracy reduced the explanatory power of African American race, such that low diabetes-related numeracy, not African American race, was significantly related to poor glycemic control. Interventions that address numeracy could help to reduce racial disparities in diabetes.
authors.affiliation: Vanderbilt University, Nashville, Tennessee, USA. chandra.osborn@vanderbilt.edu
authors.forename: Chandra Y
authors.initials: CY
authors.lastname: Osborn
authors.forename: Kerri
authors.initials: K
authors.lastname: Cavanaugh
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Wallston
authors.forename: Richard O
authors.initials: RO
authors.lastname: White
authors.forename: Russell L
authors.initials: RL
authors.lastname: Rothman
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D001786:Blood Glucose / Q000032:analysis*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000208:ethnology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D012959:Socioeconomic Factors; D055815:Young Adult; D001741:Black or African American
chemical_list: D001786:Blood Glucose