title: Association of Inadequate Health Literacy with Health Outcomes in Patients with Type 2 Diabetes and Depression: Secondary Analysis of a Controlled Trial.
abstract: OBJECTIVE
  To examine the relationship of inadequate health literacy (HL) with changes in depressive symptoms, health-related quality of life and cardiometabolic outcomes in patients with type 2 diabetes mellitus recently screened positive for depression.
  
  
  METHODS
  Secondary analysis of data from a clinical trial (N=154) that compared a collaborative team care model and enhanced usual care for primary care for patients with type 2 diabetes and depression. The exposure of interest was inadequate HL, defined as a total summative score of 9 or more on the 3 brief screening questions. Outcomes of interest were differences in the changes in depressive symptoms (Patient Health Questionnaire-9 (PHQ-9) at 12 months, health-related quality of life (short-form health survey 12 [SF-12]) and European Quality of Life-5 Dimensions questionnaire (EQ-5D), glycemic control (A1C), low-density lipoprotein cholesterol and systolic blood pressure.
  
  
  RESULTS
  The average age of patients was 58 years; 56% were women and were predominantly white. Only a small proportion (n=24; 16%) had inadequate HL. In adjusted random effects models, there were no statistically significant or clinically important differences in all outcomes between the HL groups. The between-group differences in change over 1 year were -0.55 points for PHQ-9; 0.76 points for physical and 0.56 points for mental summaries of the SF-12; 0.03 points for EQ-5D; -0.17 for A1C; -0.08 mmol/L for low-density lipoprotein; and -1.94 mm Hg for systolic blood pressure.
  
  
  CONCLUSIONS
  Among primary care patients with type 2 diabetes who had been screened recently as being positive for depression, it is unlikely that HL impacts health outcomes over 1 year.
authors.affiliation: Alliance for Canadian Health Outcomes Research in Diabetes (ACHORD), Department of Public Health Sciences, University of Alberta, Alberta, Canada.
authors.forename: Fatima
authors.initials: F
authors.lastname: Al Sayah
authors.affiliation: Department of Medicine, University of Alberta, Alberta, Canada.
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
authors.affiliation: Alliance for Canadian Health Outcomes Research in Diabetes (ACHORD), Department of Public Health Sciences, University of Alberta, Alberta, Canada. Electronic address: jeff.johnson@ualberta.ca.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Johnson
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D057220:Health Literacy / Q000639:trends; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: compétence informationnelle en santé; depression; diabetes; diabète; dépression; glycemic control; health literacy; health-related quality of life; qualité de vie liée à la santé; régulation de la glycémie