UNC study: diabetes disease management most effective for patients with low literacy

October 13, 2004
CHAPEL HILL – Primary care-based disease management programs can improve care for patients with diabetes — especially those with low literacy skills, a new University of North Carolina at Chapel Hill study concludes.The study, reported in the Oct. 13 issue of the Journal of the American Medical Association and conducted in UNC’s internal medicine practice, showed that patients with low literacy derived particular benefit in blood glucose control.

This is important, researchers say, because other studies have shown that diabetic patients with poor literacy skills are at higher risk for complications than otherwise-similar patients who read well.

“Our key finding was that the intervention we used was especially effective for low-literacy patients in boosting their skill at controlling their blood sugar,” said Dr. Michael Pignone, assistant professor of medicine at UNC and director of disease management in the UNC Center for Excellence in Chronic Illness Care.

“In fact, among diabetics with low literacy, those who received the intervention were three times more likely to achieve blood sugar goals set for them than comparable patients who served as control subjects and received only standard care.”

Besides Pignone, authors include Drs. Russell L. Rothman, a former UNC fellow in the Robert Wood Johnson Clinical Scholars Program, and statistician Ayumi Shintani, both now at Vanderbilt University Medical Center. Others, all at UNC, are Dr. Darren A. DeWalt, assistant professor of medicine; Drs. Robb Malone and Betsy Bryant, both clinical pharmacists; and Dr. Morris Weinberger, professor of health policy and administration at the school of public health.

Study participants were 217 patients ages 18 and older with type 2 diabetes who initially did poorly in controlling their blood sugar.

A multidisciplinary health-care team at UNC, anchored by clinical pharmacists, monitored all patients closely for 12 months.

The team emphasized literacy-sensitive teaching techniques, including focusing on critical actions patients should take, providing picture-based information, using concrete examples, limiting topics per session and employing the “teach back” technique to ensure patients understood and remembered what they were told.

Those with higher literacy also benefited but significantly less so than the vulnerable patients with low literacy, researchers found.

“That underscored for us the influence of literacy on patient outcomes and the importance of extra effort for diabetic patients who have had fewer educational opportunities,” Pignone said.

No previous studies have examined whether interventions for patients with diabetes differed in their effectiveness based on literacy, he said.

“Patients with diabetes and low literacy have poor knowledge of their disease and may have difficulties learning the advanced self-care skills needed to improve glycemic control, particularly in our fast-paced and complex health-care system,” the authors wrote. “Our program, with frequent one-on-one patient contact and interventions oriented toward patients with low literacy, may have helped such patients overcome barriers and fully participate in their diabetes management.”

Support for the study came from the Robert Wood Johnson Clinical Scholars Program, the UNC Program on Health Outcomes, the UNC Center for Excellence in Chronic Illness Care and Vanderbilt University.

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This release was researched and written by David Williamson of UNC News Services

Note: Pignone can be reached at (919) 966-2276, Ext. 234 or pignone@med.unc.edu, Rothman at russell.rothman@vanderbilt.edu.

News Services Contact: David Williamson, (919) 962-8596

For further information please contact Emily Smith either by phone at 919.966.8498 or by email at emily_smith@unc.edu