title: Hypoglycemia is more common among type 2 diabetes patients with limited health literacy: the Diabetes Study of Northern California (DISTANCE).
abstract: BACKGROUND
  Little is known about the frequency of significant hypoglycemic events in actual practice. Limited health literacy (HL) is common among patients with type 2 diabetes, may impede diabetes self-management, and thus HL could increase the risk of hypoglycemia.
  
  
  OBJECTIVE
  To determine the proportion of ambulatory, pharmacologically-treated patients with type 2 diabetes reporting > or =1 significant hypoglycemic events in the prior 12 months, and evaluate whether HL is associated with hypoglycemia.
  
  
  METHODS
  Cross-sectional analysis in an observational cohort, the Diabetes Study of Northern California (DISTANCE).
  
  
  METHODS
  The subjects comprised 14,357 adults with pharmacologically-treated, type 2 diabetes who are seen at Kaiser Permanente Northern California (KPNC), a non-profit, integrated health care delivery system.
  
  
  METHODS
  Patient-reported frequency of significant hypoglycemia (losing consciousness or requiring outside assistance); patient-reported health literacy.
  
  
  RESULTS
  At least one significant hypoglycemic episode in the prior 12 months was reported by 11% of patients, with the highest risk for those on insulin (59%). Patients commonly reported limited health literacy: 53% reported problems learning about health, 40% needed help reading health materials, and 32% were not confident filling out medical forms by themselves. After adjustment, problems learning (OR 1.4, CI 1.1-1.7), needing help reading (OR 1.3, CI 1.1-1.6), and lack of confidence with forms (OR 1.3, CI 1.1-1.6) were independently associated with significant hypoglycemia.
  
  
  CONCLUSIONS
  Significant hypoglycemia was a frequent complication in this cohort of type 2 diabetes patients using anti-hyperglycemic therapies; those reporting limited HL were especially vulnerable. Efforts to reduce hypoglycemia and promote patient safety may require self-management support that is appropriate for those with limited HL, and consider more vigilant surveillance, conservative glycemic targets or avoidance of the most hypoglycemia-inducing medications.
authors.affiliation: UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA, USA. usarkar@medsfgh.ucsf.edu
authors.forename: Urmimala
authors.initials: U
authors.lastname: Sarkar
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Karter
authors.forename: Jennifer Y
authors.initials: JY
authors.lastname: Liu
authors.forename: Howard H
authors.initials: HH
authors.lastname: Moffet
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Adler
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
mesh_terms: D000368:Aged; D002140:California / Q000453:epidemiology; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D057220:Health Literacy; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D057566:Self Report
chemical_list: D007004:Hypoglycemic Agents