Improving Care for Primary Care Patients With Diabetes and Poor Literacy and Numeracy Skills

Results of the National Adult Literacy Survey (NALS) suggest that over 90 million adult Americans have poor quantitative skills. Numeracy, the ability to understand and use numbers and math skills in daily life, may be particularly important to patients with diabetes because caring for diabetes often requires self-management skills that rely on the daily application of math skills, such as counting carbohydrates, interpreting blood glucose monitoring, applying sliding scale insulin regimens, and calculating insulin to carbohydrate ratios. Presumably diabetes patients with poor numeracy have more difficulty with self-management and are at risk for poorer clinical outcomes, but to date, there are no published studies that rigorously examine the role of numeracy in diabetes. We have recently completed the initial development of a new scale to measure numeracy in patients with diabetes: the Diabetes Numeracy Test (DNT).

The aim of this research will be to perform a small randomized controlled trial (RCT) of a new diabetes educational intervention that teaches self-management skills that compensate for poor literacy and numeracy skills among a sample of patients with type 2 diabetes and low numeracy or literacy skills. We hypothesize that a group of patients with poor literacy and/or numeracy who are taught self-management skills that accommodate their poor numeracy will have: (1) improved treatment satisfaction and perceived self-efficacy, (2) improved performance in self-management tasks, and (3) improved glycemic control compared to a control group that receives usual education and care.

• Behavioral: Literacy/Numeracy oriented educational intervention
  Receives comprehensive literacy/num sensitive diabetes care
• Behavioral: Control Group
  Receives standard diabetes disease management

• Active Comparator: Control
  Control Arm receives standard diabetes disease management
  Intervention: Behavioral: Control Group
• Experimental: Intervention Arm
  Receives numeracy/literacy sensitive diabetes management
  Intervention: Behavioral: Literacy/Numeracy oriented educational intervention

Inclusion Criteria:

1. Clinical diagnosis of Type 2 Diabetes
2. most recent A1C >= 7.5%
3. Referred to the Diabetes Care Program for diabetes care
4. Age 18-85; 5. English Speaking.

Exclusion Criteria:

1. Patients with corrected visual Acuity >20/50 using a Rosenbaum Pocket Vision Screener
2. Patients with a diagnosis of significant dementia, psychosis, or blindness.

• University of North Carolina, Chapel Hill
• American Diabetes Association
• Pfizer