Health literacy and glycemic control in patients with diabetes: a tertiary care center study in Brazil

Marilia B Gomes; Luiza Harcar Muniz; Laura Gomes Nunes Melo; Marcela Haas Pizarro; Bianca Senger Vasconcelos Barros; Deborah Conte Santos; Carlos Antonio Negrato

doi:10.1186/s13098-020-0519-6

Health literacy and glycemic control in patients with diabetes: a tertiary care center study in Brazil

Diabetol Metab Syndr. 2020 Feb 3:12:11. doi: 10.1186/s13098-020-0519-6. eCollection 2020.

Authors

Marilia B Gomes¹, Luiza Harcar Muniz¹, Laura Gomes Nunes Melo¹, Marcela Haas Pizarro¹, Bianca Senger Vasconcelos Barros¹, Deborah Conte Santos¹, Carlos Antonio Negrato²

Affiliations

¹ Diabetes Unit, Department of Internal Medicine, State University Hospital of Rio de Janeiro, Rio de Janeiro, Brazil.
² 2Medical Doctor Program, University of São Paulo-School of Dentistry, Bauru, São Paulo, Brazil.

Abstract

Background: The primary objective of our study was to determine which factors influence health literacy (HL) in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D), and the secondary one was to evaluate the influence of HL on glycemic control.

Methods: This was an observational, cross-sectional study with 347 patients (144 with T1D and 203 with T2D), conducted between December 2014/December 2017. Data were obtained from medical records and/or questionnaire. The short test of Functional Health Literacy (S-TOFHLA) was used to evaluate HL.

Results: Age and years of school attendance were the most important variables associated with better performance in S-TOFHLA mainly in patients with T1D. A correlation between age and years of school attendance with S-TOFHLA score was observed in both groups of patients. After an unadjusted analysis, more patients with T1D presented adequate HL [119 (82.6%) vs 87 (44.8%, p < 0.001)]. Patients with T1D had higher scores than patients with T2D (84.4 ± 21.4 vs 61.6 ± 26.8 points, p < 0.001), respectively. This difference did not persist after adjustment for age and years of school attendance (73.04 ± 2.14 ± vs 70.04 ± 1.76 points) respectively, p = 0.348). No difference was found in HbA1c levels according to S-TOFHLA. All patients with T1D and HbA1c levels < 7.0% (53 mmol/mol) had adequate HL.

Conclusions: A considerable number of patients with either T1D or T2D did not have adequate HL. Overall, age and years of school attendance were the most important variables associated with better performance of S-TOFHLA. Although no difference was found in HbA1c levels according to S-TOFHLA, patients with T1D who self-reported as White, with more years of school attendance, and higher HL score reached more frequently a good glycemic control. Finally, in addition to therapeutic regimens, approaches on diabetes management should also include patients' HL evaluation along with psychological and social aspects.

Keywords: Diabetes management; Glycemic control; Health literacy; Type 1 diabetes; Type 2 diabetes.