Addressing Literacy and Numeracy to Improve Diabetes Care

Addressing Literacy and Numeracy to Improve Diabetes Care Two randomized controlled trials Kerri Cavanaugh , MD, MHS 1 , 2 , Kenneth A. Wallston , PHD 3 , Tebeb Gebretsadik , MPH 4 , Ayumi Shintani , PHD, MPH 4 , Mary Margaret Huizinga , MD, MPH 5 , Dianne Davis , RD, CDE 2 , Rebecca Pratt Gregory , RD, CDE 2 , Robb Malone , PHARMD, CDE 6 , 7 , Michael Pignone , MD, MPH 6 , Darren DeWalt , MD, MPH 6 , Tom A. Elasy , MD, MPH 2 , 8 and Russell L. Rothman , MD, MPP 2 , 8 , 9 1 Division of Nephrology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; 2 Vanderbilt Eskind Diabetes Center, Diabetes Research and Training Center, Vanderbilt University, School of Medicine, Nashville, Tennessee; 3 School of Nursing, Vanderbilt University Medical Center, Nashville, Tennessee; 4 Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; 5 Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; 6 Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; 7 Division of Pharmacy Practice and Experiential Education, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina; 8 VA Tennessee Valley Healthcare System, VA Quality Scholars Program, Nashville, Tennessee; 9 Division of General Medicine and Public Health, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee. Corresponding author: Russell L. Rothman, russell.rothman{at}vanderbilt.edu . Abstract OBJECTIVE Diabetic patients with lower literacy or numeracy skills are at greater risk for poor diabetes outcomes. This study evaluated the impact of providing literacy- and numeracy-sensitive diabetes care within an enhanced diabetes care program on A1C and other diabetes outcomes. RESEARCH DESIGN AND METHODS In two randomized controlled trials, we enrolled 198 adult diabetic patients with most recent A1C ≥7.0%, referred for participation in an enhanced diabetes care program. For 3 months, control patients received care from existing enhanced diabetes care programs, whereas intervention patients received enhanced programs that also addressed literacy and numeracy at each institution. Intervention providers received health communication training and used the interactive Diabetes Literacy and Numeracy Education Toolkit with patients. A1C was measured at 3 and 6 months follow-up. Secondary outcomes included self-efficacy, self-ma