Thought Leadership in Action

More than 29 million people in the US have diabetes, according to the Centers for Disease Control and Prevention (CDC) -- and the vast majority have type 2, a condition linked to being overweight and lack of exercise. In fact, the CDC says type 2 diabetes has reached epidemic proportions in the US. The personal and economic repercussions affect not only individuals and their families, but also employers. CDC statistics show diabetes and its related complications account for $245 billion annually in total medical costs and lost work and wages.

Although type 2 diabetes can often be prevented if people at risk make lifestyle changes, researchers have also found that people diagnosed with the condition can improve symptoms, help to prevent serious complications and sometimes even reverse the disease by making healthy lifestyle changes (including regular exercise, good nutrition and weight loss) and keeping blood sugar under control.

So why are so many type 2 diabetes patients not improving? A new study from the University of Pennsylvania, published in The Diabetes Educator journal, shows health illiteracy may be an important factor.

Bottom line: Many type 2 diabetes patients think they are following all the appropriate medical guidelines for their condition -- but they aren’t. When type 2 diabetes patients mistakenly believe they have their condition under control, they may be less likely to make the necessary changes to improve their glucose measurements, according to the study.

Using in-person interviews, the researchers investigated whether patients with type 2 diabetes thought they were handling their condition well. The research team also used the Rapid Estimate of Adult Literacy in Medicine survey to measure the patients’ health literacy. The results showed that the less knowledgeable patients were about health and medicine, the more they believed they were doing everything necessary to control their type 2 diabetes and that they were managing the condition well or very well.

The researchers noted health illiteracy is not uncommon and that people with type 2 diabetes who are not adequately controlling their condition may simply have not received enough information that they understand. For example, doctors sometimes wrongly assume patients are familiar with technical information about medical tests such as HbA1c levels, which measure the average level of blood sugar over the previous three months and shows how well diabetes is being controlled.

The University of Pennsylvania research team said working with patients on goals to improve their condition (like following a nutritious diet, losing weight, giving up cigarettes and exercising regularly) could be more helpful than concentrating on lab test information that isn’t understood. “The findings from this study suggest that recognizing just how common low health literacy is in patients with diabetes is important for diabetes educators and should thus inform communication strategies regarding HbA1c and the control of diabetes,” Monica O. Ferguson, MD, who headed the research, and her colleagues concluded.

“Effective communication strategies appropriate for all patients regardless of their health literacy are essential, and these strategies must improve the accuracy of perceived control in poorly controlled patients.” The takeaway message from the study suggests healthcare providers and anyone working to educate people about type 2 diabetes should consider health literacy when discussing diabetes control and health goals, according to the researchers.

 For more information on how people with type 2 diabetes can successfully learn about their condition and manage it, download the “4 Steps to Manage Your Diabetes for Life” offered by the National Diabetes Education Program, a partnership with the National Institutes of Health and the CDC.