Skip to main content
SpringerLink
Log in

LitKDM2 study: the impact of health Literacy and knowledge about the disease on the metabolic control of type 2 diabetes mellitus

  • Original Article
  • Published:
Acta Diabetologica Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 25 October 2022

Abstract

Aims

Diabetes mellitus (DM) is a common chronic disease with serious individual and socioeconomic consequences. Low health literacy (HL) has been associated with higher morbimortality. Health knowledge about DM (HK-DM) may also influence individual health. We aimed to assess HL and HK-DM in patients with type 2 DM and their associations with metabolic control.

Methods

Our sample comprised 194 diabetic patients from a primary care health centre. We collected clinical and demographic data and applied two validated questionnaires, the Newest Vital Sign (NST) and Diabetes Knowledge Test (DKT), to assess HL and HK-DM, respectively. Metabolic control was defined as HbA1c < 7.0%. Participants were classified according to the NST as having “high likelihood of limited HL” (HLL-HL), “possibility of limited HL” (PL-HL), or “adequate HL” (A-HL) and by the DKT as having “low”, “average” and “good” HK. Statistical analysis included logistic regression models, using p < 0.05 as a cut-off for statistical significance.

Results

Overall, 72.7 and 34.7% of participants had HLL-HL and low HK-DM, respectively. A-HL (OR = 6.02; 95% CI: 1.691–21.450) and PL-HL (OR = 4.78; 95% CI: 1.350–16.899) were significantly associated with better metabolic control than HLL-HL. We did not find a significant association between HK-DM and metabolic control.

Conclusions

HL seems to be associated with better metabolic control. We also found a high prevalence of illiteracy and scarce knowledge about DM. Primary care physicians should promote HL to help patients achieve better metabolic control.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lin X, Xu Y, Pan X et al (2020) Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025. Sci Rep 10(1):14790. https://doi.org/10.1038/s41598-020-71908-9

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Bommer C, Sagalova V, Heesemann E et al (2018) Global economic burden of diabetes in adults: projections from 2015 to 2030. Diabetes Care 41(5):963–970. https://doi.org/10.2337/dc17-1962

    Article  PubMed  Google Scholar 

  3. Wild S, Roglic G, Green A, Sicree R, King H (2004) Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 27(5):1047–1053. https://doi.org/10.2337/diacare.27.5.1047

    Article  PubMed  Google Scholar 

  4. Boyle JP, Honeycutt AA, Narayan KM et al (2001) Projection of diabetes burden through 2050: impact of changing demography and disease prevalence in the US. Diabetes Care 24(11):1936–1940. https://doi.org/10.2337/diacare.24.11.1936

    Article  CAS  PubMed  Google Scholar 

  5. WH Organization (1998) Health promotion glossary. World Health Organization, Geneva

    Google Scholar 

  6. Nutbeam D (2008) The evolving concept of health literacy. Soc Sci Med 67(12):2072–2078. https://doi.org/10.1016/j.socscimed.2008.09.050

    Article  PubMed  Google Scholar 

  7. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K (2011) Low health literacy and health outcomes: an updated systematic review. Ann Intern Med 155(2):97–107. https://doi.org/10.7326/0003-4819-155-2-201107190-00005

    Article  PubMed  Google Scholar 

  8. Bostock S, Steptoe A (2012) Association between low functional health literacy and mortality in older adults: longitudinal cohort study. BMJ 344:e1602. https://doi.org/10.1136/bmj.e1602

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hess GE, Davis WK (1983) The validation of a diabetes patient knowledge test. Diabetes Care Nov-Dec 6(6):591–596. https://doi.org/10.2337/diacare.6.6.591

    Article  CAS  Google Scholar 

  10. Fenwick EK, Xie J, Rees G, Finger RP, Lamoureux EL (2013) Factors associated with knowledge of diabetes in patients with type 2 diabetes using the DKT validated with rasch analysis. PLoS ONE 8(12):e80593. https://doi.org/10.1371/journal.pone.0080593

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Marciano L, Camerini AL, Schulz PJ (2019) The role of health literacy in diabetes knowledge, self-care, and glycemic control: a meta-analysis. J Gen Intern Med 34(6):1007–1017. https://doi.org/10.1007/s11606-019-04832-y

    Article  PubMed  PubMed Central  Google Scholar 

  12. Barreto M, Kislaya I, Gaio V et al (2018) Prevalence, awareness, treatment and control of diabetes in Portugal: results from the first national health examination survey (INSEF 2015). Diabetes Res Clin Pract 140:271–278. https://doi.org/10.1016/j.diabres.2018.03.052

    Article  PubMed  Google Scholar 

  13. Paiva D, Silva S, Severo M et al (2017) Limited health literacy in Portugal assessed with the newest vital sign. Acta Med Port 30(12):861–869. https://doi.org/10.20344/amp.9135

    Article  PubMed  Google Scholar 

  14. Azevedo C, Santiago L (2016) DKT feasibility in Portugal. Acta Med Port 29(9):499–506. https://doi.org/10.20344/amp.7517

    Article  PubMed  Google Scholar 

  15. AD Association (2021) 16. Diabetes advocacy: standards of medical care in diabetes. Diabetes Care 44(Supplement 1):S221–S222. https://doi.org/10.2337/dc21-S016

    Article  Google Scholar 

  16. Narayan KMV (2005) The diabetes pandemic: looking for the silver lining. Clin Diabetes 23(2):51–52. https://doi.org/10.2337/diaclin.23.2.51

    Article  Google Scholar 

  17. OECD (2017) Health at a Glance

  18. Rubin RR, Peyrot M (1999) Quality of life and diabetes. Diabetes Metab Res Rev 15(3):205–218. https://doi.org/10.1002/(sici)1520-7560(199905/06)15:3%3c205::aid-dmrr29%3e3.0.co;2-o

    Article  CAS  PubMed  Google Scholar 

  19. Cannon A, Handelsman Y, Heile M, Shannon M (2018) Burden of illness in type 2 diabetes mellitus. J Manag Care Spec Pharm 24(9a-Suppl):s5–s13. https://doi.org/10.18553/jmcp.2018.24.9-a.s5

    PubMed  Google Scholar 

  20. Fowler MJ (2008) Microvascular and macrovascular complications of diabetes. Clin Diabetes 26(2):77–82. https://doi.org/10.2337/diaclin.26.2.77

    Article  Google Scholar 

  21. Colberg SR, Sigal RJ, Fernhall B et al (2010) Exercise and type 2 diabetes: the american college of sports medicine and the american diabetes association: joint position statement. Med Sci Sports Exerc 33(12):e147–e167. https://doi.org/10.2337/dc10-9990

    Google Scholar 

  22. Franz MJ et al (2003) Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care 26(suppl 1):s51–s61. https://doi.org/10.2337/diacare.26.2007.S51

    PubMed  Google Scholar 

  23. Kumah E, Afriyie EK, Abuosi AA et al (2021) Influence of the model of care on the outcomes of diabetes self-management education program: a scoping review. J Diabetes Res 2021:2969243. https://doi.org/10.1155/2021/2969243

    Article  PubMed  PubMed Central  Google Scholar 

  24. Pedro AR, Amaral O, Escoval A (2016) Literacia em saúde, dos dados à ação: tradução, validação e aplicação do European health literacy survey em Portugal. Revista Port de Saúde Pública 34(3):259–275. https://doi.org/10.1016/j.rpsp.2016.07.002

    Article  Google Scholar 

  25. Broos B, Charleer S, Bolsens N et al (2021) Diabetes knowledge and metabolic control in type 1 diabetes starting with continuous glucose monitoring: FUTURE-PEAK. J Clin Endocrinol Metab 106(8):e3037–e3048. https://doi.org/10.1210/clinem/dgab188

    Article  PubMed  Google Scholar 

  26. Hussein SH, Albatineh AN, Almajran A, Ziyab AH (2021) Association of health literacy and other risk factors with glycemic control among patients with type 2 diabetes in Kuwait: a cross-sectional study. Prim Care Diabetes 15(3):571–577. https://doi.org/10.1016/j.pcd.2021.01.011

    Article  PubMed  Google Scholar 

  27. Doubova SV, Infante C, Villagrana-Gutiérrez GL, Martínez-Vega IP, Pérez-Cuevas R (2019) Adequate health literacy is associated with better health outcomes in people with type 2 diabetes in Mexico. Psychol Health Med 24(7):853–865. https://doi.org/10.1080/13548506.2019.1574356

    Article  PubMed  Google Scholar 

  28. Pfizer Inc (2011) The newest vital sign—a health literacy assessment tool. https://cdn.pfizer.com/pfizercom/health/nvs_flipbook_english_final.pdf. Accessed 1 June 2021

  29. Weiss BD, Mays MZ, Martz W et al (2005) Quick assessment of literacy in primary care: the newest vital sign. Ann Fam Med 3(6):514–522. https://doi.org/10.1370/afm.405

    Article  PubMed  PubMed Central  Google Scholar 

  30. Rothman RL, Housam R, Weiss H et al (2006) Patient understanding of food labels: the role of literacy and numeracy. Am J Prev Med 31(5):391–398. https://doi.org/10.1016/j.amepre.2006.07.025

    Article  PubMed  Google Scholar 

  31. Caruso R, Magon A, Baroni I et al (2018) Health literacy in type 2 diabetes patients: a systematic review of systematic reviews. Acta Diabetol 55(1):1–12. https://doi.org/10.1007/s00592-017-1071-1

    Article  PubMed  Google Scholar 

  32. Dawson AZ, Walker RJ, Egede LE (2017) Differential relationships between diabetes knowledge scales and diabetes outcomes. Diabetes Educ 43(4):360–366. https://doi.org/10.1177/0145721717713316

    Article  PubMed  PubMed Central  Google Scholar 

  33. van der Heide I, Uiters E, Rademakers J et al (2014) Associations among health literacy, diabetes knowledge, and self-management behavior in adults with diabetes: results of a dutch cross-sectional study. J Health Commun 19(Suppl 2):115–131. https://doi.org/10.1080/10810730.2014.936989

    Article  PubMed  Google Scholar 

  34. Paiva D, Silva S, Severo M et al (2014) Cross-cultural adaptation and validation of the health literacy assessment tool METER in the Portuguese adult population. Patient Educ Couns 97(2):269–275. https://doi.org/10.1016/j.pec.2014.07.024

    Article  PubMed  Google Scholar 

  35. Pires C, Rosa P, Vigário M, Cavaco A (2018) Short assessment of health literacy (SAHL) in Portugal: development and validation of a self-administered tool. Prim Health Care Res Dev 20:1–18. https://doi.org/10.1017/s1463423618000087

    Google Scholar 

  36. Rawson KA, Gunstad J, Hughes J et al (2010) The METER: a brief, self-administered measure of health literacy. J Gen Intern Med 25(1):67–71. https://doi.org/10.1007/s11606-009-1158-7

    Article  PubMed  Google Scholar 

  37. Observatório Regional de Saúde (2017) Perfil local de Saúde, ACeS Gaia e Espinho/Gaia

  38. Fitzgerald JT, Funnell MM, Anderson RM et al (2016) Validation of the revised brief DKT (DKT2). Diabetes Educ 42(2):178–187. https://doi.org/10.1177/0145721715624968

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge all the elements of our administrative and nurse staff for their help with the convocation of participants and complete availability.

Author information

Authors and Affiliations

  1. Family Health Unit St. André de Canidelo, R. das Fábricas, 282, 4400-712, Vila Nova de Gaia, Portugal

    Isabel Ralha de Abreu, Catarina Baía, Jorge Manuel Silva, Ana Matos Santos, Filipa Castro, Mónica Mozes, Rute Ferreira & Luís Amorim Alves

  2. Family Health Unit Avintes, Vila Nova de Gaia, Portugal

    Ana Matos Santos

  3. Health Personalized Care Unit Oliveira Do Douro, Vila Nova de Gaia, Portugal

    Mafalda Oliveira

  4. Institute of Biomedical Sciences Abel Salazar, Porto, Portugal

    Luís Amorim Alves

  5. EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal

    Luís Amorim Alves

  6. Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal

    Luís Amorim Alves

Authors
  1. Isabel Ralha de Abreu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Catarina Baía
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jorge Manuel Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ana Matos Santos
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mafalda Oliveira
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Filipa Castro
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mónica Mozes
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rute Ferreira
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Luís Amorim Alves
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

IRA involved in conception and design of the work; implementation and analysis (questionnaires and statistics) and interpretation of data (results and discussion); review of bibliography; drafting of the work and review of the intellectual content; and final approval of the version to be published. CB involved in conception and design of the work; implementation and analysis (questionnaires and statistics) and interpretation of data (results and discussion); review of bibliography; drafting of the work and review of the intellectual content; and final approval of the version to be published. JMS involved in conception and design of the work; implementation and analysis (questionnaires and statistics) and interpretation of data (results and discussion); review of bibliography; drafting of the work and review of the intellectual content; and final approval of the version to be published. AMS involved in conception and design of the work; implementation; drafting of the work; and final approval of the version to be published. MO involved in conception and design of the work; implementation; drafting of the work; and final approval of the version to be published. FC involved in conception and design of the work; implementation; review of the intellectual content; and final approval of the version to be published. MM involved in conception and design of the work; implementation; review of the intellectual content; and final approval of the version to be published. RF involved in conception and design of the work; implementation; review of the intellectual content; and final approval of the version to be published. LAA involved in conception and design of the work; implementation and analysis (questionnaires and statistics); review of the intellectual content and scientific misspelling; and final approval of the version to be published.

Corresponding author

Correspondence to Jorge Manuel Silva.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Consent to participate

Written informed consent was obtained from all individual participants in the study.

Consent to publish

Patients signed informed consent regarding publishing their data.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee for Health (005/2020; study T1142) of the Administração Regional do Norte, Portugal.

Humans or animals rights

The authors declare that the procedures were followed according to the regulations established by the Clinical Research and Ethics Committee and to the Helsinki Declaration of the World Medical Association updated in 2013.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article belongs to the topical collection Health Education and Psycho-Social Aspects, managed by Massimo Porta and Marina Trento.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

de Abreu, I.R., Baía, C., Silva, J.M. et al. LitKDM2 study: the impact of health Literacy and knowledge about the disease on the metabolic control of type 2 diabetes mellitus. Acta Diabetol 59, 819–825 (2022). https://doi.org/10.1007/s00592-022-01875-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00592-022-01875-2

Keywords

Search

Navigation