Literacy and Managing Diabetes

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Rothman R, DeWalt D, Malone R, et al.: Influence of patient literacy on the effectiveness of a primary care-based diabetes disease management program. JAMA 292:1711-1716, 2004

What is the problem and what is known about it?

About 90 million Americans cannot read or write well enough to take care of themselves. These people clearly have trouble reading medicine bottles, following their doctor's orders, and understanding their illnesses, and usually have poorer long-term health than people who can read and write. Many people who have diabetes also have trouble reading and writing. These people have a more difficult time caring for their diabetes.

In this study, researchers wanted to see if a class teaching people with poor reading and writing skills how to better manage their diabetes would help their health.

Who was studied?

A total of 217 patients who were all 18 years old or older and had type 2 diabetes were studied. They were studied from February 2001 to April 2003. All the participants had poor control over their glucose levels. Some people in the study had low reading and writing skills and others could read and write very well.

How was the study done?

Participants were divided into two groups. One group received special training classes and one-on-one instruction on how to best manage diabetes. Group 2 received just one class and normal care from their doctor.

Researchers measured blood glucose levels and A1C, which is a measure of long-term glucose control. Lab tests were run at the beginning of the study and after 12 months.

What did the researchers find?

The patients who had low reading and writing skills in Group 1 did well at gaining control over their blood glucose levels. The patients who had high reading and writing skills also did well at improving their control over the diabetes. It didn't matter which group the people with good reading and writing skills were in.

What were the limitations of this study?

This was a small study, which was conducted at a single location. Studies in the future may include other areas and more people.

What are the implications of the study?

Offering several diabetes education classes and a lot of one-on-one contact for people with low reading and writing skills may be the best way to help them take better care of their blood glucose.