What Works in Diabetes Patients with Low Health Literacy

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Multifaceted and personalized interventions are the best methods in achieving positive outcomes in diabetes patients with inadequate health literacy, according to Darren A. DeWalt, MD, assistant professor at the University of North Carolina School of Medicine, who presented his findings today in a session titled “Health Literacy—Interventions that Work” at the 70 Scientific Sessions of the American Diabetes Association.

Dr. DeWalt conducted a systematic review using the keywords “diabetes” and “literacy” among intervention studies and came up with 10 studies meeting the criteria. The studies were conducted from 2004-2009 and all took place in the primary care setting and featured type 2 diabetes patients, with some type 1 patients involved as well. There were four types of interventions featured in the studies: pure education, action plan, disease management, and notifying clinician of literacy level.

What Dr. DeWalt found after investigating these studies was that while most of them improved the knowledge of their participants, none of them narrowed the gap between low- and high-health literate patients. But some interventions did improve certain key aspects of diabetes care.

According to Dr. DeWalt’s study, self-efficacy was improved by using the ACPF Diabetes Guide and personal coaching to set action plans in one study, as well as by diabetes education from a nutritionist and case management-type services in another. Blood pressure was improved by using an automated telephone service to counsel patients in disease management when combined with group visits and their usual care plan. Blood pressure improvement was also seen in a study using intensive diabetes education and support when compared to just usual care. Patients received intensive education as well as coordinated care and received a phone call once a month to follow-up on their progress. Their improvements over those who received just a single session proved what many already believed, that a single educational session is not enough to positively affect outcomes.

Dr. DeWalt also discovered in one study that when patients used the Diabetes Literacy and Numeracy Education Tool Kit, along with visits from a nurse or certified diabetes educator and a nutritionist, as well as their regular primary care, their blood glucose levels improved by 1.5% compared to the control group who only saw an improvement of 0.8%. But what that study found was that when the intensive sessions were over after three months, the intervention group waned in their care, and the significance in their blood pressure improvement disappeared, leaving Dr. DeWalt to conclude that something else must be in play because he doesn’t believe they could have just forgot everything they learned over the previous three months.

What reviewing all of these studies taught Dr. DeWalt was what works and what doesn’t work when managing diabetes patients with low health literacy. He concludes that simply making the physician aware of the patients low health literacy isn’t enough because no significant change will occur. He also found out that multimedia teaching tools are ineffective as well, but believes that someday they could be useful, just not right now. But there are some very useful methods that can improve the care and help patients with low health literacy achieve favorable outcomes.

Positive outcomes can be achieved by paying attention to the whole patient, which includes what goes on in their life that could affect their health, identifying educational and support needs and reinforcing and repeating what they have been taught. Designing the educational programs from the patient perspective and integrating the educational and clinical decisions in a teamwork approach is also important in achieving the goals set forth by both the patient and physician. By combining all of these methods into a multifaceted, personalized care plan, the diabetes patient with low health literacy has the best chance to meet their goals and successfully manage their disease.