Outcomes/Effectiveness Research

Patients with adult-onset diabetes with limited health literacy more likely to suffer hypoglycemic episodes

Patients with adult-onset (type 2) diabetes have excessively high blood-sugar levels that often must be controlled with medication. Patients with this condition have more difficulty controlling their blood sugar level if they have limited health literacy, according to a new study.

The researchers examined the impact of various health literacy problems on the ability of 14,357 patients recruited from a California diabetes registry to manage their disease. Of this group, 11 percent reported having a severe episode of low blood sugar (hypoglycemia) during the past year. The risk of hypoglycemia was highest for those using insulin (59 percent). Problems with health literacy were common among the patients, with 53 percent reporting problems learning about health, 40 percent needing help reading health information materials, and 32 percent saying they did not feel confident filling out medical forms by themselves.

These three health literacy problems remained independently associated with the risk of experiencing significant hypoglycemia, even after the researchers adjusted the findings for demographic factors, clinical factors (e.g., medication type and disease duration), and English proficiency. The adjusted risk was 40 percent higher for patients reporting problems learning about health, and 30 percent higher for patients reporting either reading problems or lack of confidence filling out forms. The study was funded in part by the Agency for Healthcare Research and Quality (HS17594 and HS17261).

More details are in "Hypoglycemia is more common among type 2 diabetes patients with limited health literacy: The diabetes study of northern California (DISTANCE)," by Urmimala Sarkar, M.D., Ph.D., Andrew J. Karter, Ph.D., Jennifer Y. Liu, M.P.H., and others in the Journal of General Internal Medicine, published online May 18, 2010, at http://dx.doi.org/10.1007/s11606-010-1389-7.

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