title: Update on health literacy and diabetes.
abstract: Inadequate literacy is common among patients with diabetes and may lead to adverse outcomes. The authors reviewed the relationship between literacy and health outcomes in patients with diabetes and potential interventions to improve outcomes.
  
  
  
  We reviewed 79 articles covering 3 key domains: (1) evaluation of screening tools to identify inadequate literacy and numeracy, (2) the relationships of a range of diabetes-related health outcomes with literacy and numeracy, and (3) interventions to reduce literacy-related differences in health outcomes.
  
  
  
  Several screening tools are available to assess patients' print literacy and numeracy skills, some specifically addressing diabetes. Literacy and numeracy are consistently associated with diabetes-related knowledge. Some studies suggest literacy and numeracy are associated with intermediate outcomes, including self-efficacy, communication, and self-care (including adherence), but the relationship between literacy and glycemic control is mixed. Few studies have assessed more distal health outcomes, including diabetes-related complications, health care utilization, safety, or quality of life, but available studies suggest low literacy may be associated with increased risk of complications, including hypoglycemia. Several interventions appear to be effective in improving diabetes-related outcomes regardless of literacy status, but it is unclear if these interventions can reduce literacy-related differences in outcomes.
  
  
  
  Low literacy is associated with less diabetes-related knowledge and may be related to other important health outcomes. Further studies are needed to better elucidate pathways by which literacy skills affect health outcomes. Promising interventions are available to improve diabetes outcomes for patients with low literacy; more research is needed to determine their effectiveness outside of research settings.
authors.affiliation: Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA (Dr Bailey)
authors.forename: Stacy Cooper
authors.initials: SC
authors.lastname: Bailey
authors.affiliation: Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, USA (Dr Brega)
authors.forename: Angela G
authors.initials: AG
authors.lastname: Brega
authors.affiliation: Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA (Ms Crutchfield)
authors.forename: Trisha M
authors.initials: TM
authors.lastname: Crutchfield
authors.affiliation: Division of General Internal Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, TN, USA (Drs Elasy, Osborn, and Rothman)
authors.forename: Tom
authors.initials: T
authors.lastname: Elasy
authors.affiliation: Brown School of Social Work, Washington University in St Louis, St Louis, MO, USA (Ms Herr and Dr Moreland-Russell)
authors.forename: Haley
authors.initials: H
authors.lastname: Herr
authors.affiliation: Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St Louis, St Louis, MO, USA (Dr Kaphingst)
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kaphingst
authors.affiliation: Kaiser Permanente Division of Research, Oakland, CA, USA (Dr Karter)
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Karter
authors.affiliation: Brown School of Social Work, Washington University in St Louis, St Louis, MO, USA (Ms Herr and Dr Moreland-Russell)
authors.forename: Sarah
authors.initials: S
authors.lastname: Moreland-Russell
authors.affiliation: Division of General Internal Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, TN, USA (Drs Elasy, Osborn, and Rothman)
authors.forename: Chandra Y
authors.initials: CY
authors.lastname: Osborn
authors.affiliation: Division of General Internal Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA (Dr Pignone)
authors.forename: Michael
authors.initials: M
authors.lastname: Pignone
authors.affiliation: Vanderbilt Center for Health Services Research, Nashville, TN, USA (Dr Rothman)
authors.forename: Russell
authors.initials: R
authors.lastname: Rothman
authors.affiliation: Division of General Internal Medicine, University of California San Francisco, and Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA, USA (Dr Schillinger)
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D048909:Diabetes Complications / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology; D019317:Evidence-Based Medicine; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy / Q000706:statistics & numerical data; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D008403:Mass Screening; D055641:Mathematical Concepts; D011788:Quality of Life; D018570:Risk Assessment; D012646:Self Administration; D012648:Self Care / Q000706:statistics & numerical data*; D020377:Self Efficacy; D016903:Drug Monitoring
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents