Background:  The influence of a patient’s quantitative skills (numeracy) on the management of diabetes is only partially understood.

Objective: To examine the association between diabetes-related numeracy and glycemic control and other diabetes measurements.

Design: Cross-sectional survey.

Setting: 2 primary care and 2 diabetes clinics at 3 medical centers.

Participants: 398 adult patients with type 1 or type 2 diabetes mellitus enrolled between March 2004 and November 2005.

Measurements: Health literacy, general numeracy, and diabetes-related numeracy assessed by using the Rapid Estimate of Adult Literacy in Medicine; the Wide Range Achievement Test, 3rd edition; and the Diabetes Numeracy Test (DNT), respectively. The primary outcome was most recent level of hemoglobin A1c. Additional measurements were diabetes knowledge, perceived self-efficacy of diabetes self-management, and self-management behaviors.

Results: The median DNT score was 65% (interquartile range, 42% to 81%). Common errors included misinterpreting glucose meter readings and miscalculating carbohydrate intake and medication dosages. Lower DNT scores were associated with older age, nonwhite race, fewer years of education, lower reported income, lower literacy and general numeracy skills, lower perceived self-efficacy, and selected self-management behaviors. Patients scoring in the lowest DNT quartile (score < 42%) had a median hemoglobin A1c level of 7.6% (interquartile range, 6.5% to 9.0%) compared with 7.1% (interquartile range, 6.3% to 8.1%) in those scoring in the highest quartile (P = 0.119 for trend). A regression analysis adjusted for age, sex, race, income, and other factors found a modest association between DNT score and hemoglobin A1c level.

Limitation: Causality cannot be determined in this cross-sectional study, especially with its risk for unmeasured confounding variables.

Conclusion: Poor numeracy skills were common in patients with diabetes. Low diabetes-related numeracy skills were associated with worse perceived self-efficacy, fewer self-management behaviors, and possibly poorer glycemic control.

Editors’ Notes

Context

  * Self-management of diabetes often involves interpretation of quantitative information and performing calculations. Poor numeracy skills could have an effect on diabetes management.

Contribution

  * The authors measured diabetes management–related numeracy skills and hemoglobin A1c in a sample of 398 diabetic patients from primary care clinics and diabetes clinics at 3 medical centers. Many could not calculate the calories in a bag of potato chips or recognize a very low blood glucose value. Hemoglobin A1c levels were slightly worse in patients with poor diabetes-related numeracy, more so if young, less literate, or with recent diagnosis.

Implication

  * Poor diabetes-related numeracy is common but is weakly related to glycemic control.

Author and Article Information

Requests for Single Reprints: Russell L. Rothman, MD, MPP, Vanderbilt University Medical Center, 6100 Medical Center East, North Tower, Vanderbilt Center for Health Services Research, Nashville, TN 37232-8300; e-mail, .(JavaScript must be enabled to view this email address).

Current Author Addresses: Dr. Cavanaugh: Vanderbilt University, 1161 21st Avenue South, 5-3223 Medical Center North, Nashville, TN 37232.

Drs. Huizinga and Rothman: Vanderbilt University, 1215 21st Avenue South, 6100 Medical Center East, North Tower, Nashville, TN 37232.

Dr. Wallston: Vanderbilt University, 421 Godchaux Hall, 461 21st Avenue South, Nashville, TN 37240.

Drs. Gebretsadik and Shintani: Vanderbilt University, 1211 21st Avenue South, S-2323 Medical Center North, Nashville, TN 37232.

Dr. Davis: Vanderbilt University, 1211 21st Avenue South, 3061 Medical Arts Building, Nashville, TN 37212.

Dr. Pratt Gregory: Vanderbilt University Diabetes Center, 315 Med Arts, 1211 21st Avenue South, Nashville, TN 37212.

Dr. Fuchs: Vanderbilt University, 228 Peabody, 230 Appleton Place, Nashville, TN 37220.

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