Limited health literacy increased safety risks for patients with diabetes

Patients with diabetes who have limited health literacy are at significantly greater risk for hypoglycemia, according to new data.

Researchers used health literacy surveys to determine literacy levels and patient-reported frequency of significant hypoglycemia involving loss of consciousness or requiring outside assistance among 14,357 adults with pharmacologically-treated type 2 diabetes. All were included in the Diabetes Study of Northern California (DISTANCE).

Eleven percent of adults reported experiencing at least one significant episode of hypoglycemia in the prior 12 months. The highest risk was reported among patients using insulin (59%).

Limited health literacy was common, according to the results. Fifty-three percent reported having problems learning about their health, 40% had difficult and required assistance in reading health materials, and 32% were not confident filling out medical forms.

Limited health literacy, specifically problems learning about personal health (OR=1.4; 95% CI, 1.1-1.7), needing held reading health materials (OR=1.3; 95% CI, 1.1-1.6) and lack of confidence when filling out medical forms (OR=1.3; 95% CI, 1.1-1.6), were independently associated with significant hypoglycemia.

“The frequency of significant hypoglycemia suggests that more surveillance and monitoring are needed,” Urmimala Sarkar, MD, assistant professor of medicine in residence at the University of California, San Francisco, said in a press release.

To eliminate this excess risk for hypoglycemia, the researchers recommended that physicians ask patients about hypoglycemia symptoms at every visit, ensure that patients fully understand medication instructions, and be cautious about performance standards for glucose control.

Sarkar U. J Gen Intern Med. doi:10.1007/s11606-010-1389-7.