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19-05-2010 | Diabetes | Article

Limited health literacy increases risk for hypoglycemia in Type 2 diabetics


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MedWire News: Limited health literacy significantly increases the risk for hypoglycemia in patients with Type 2 diabetes, report researchers.

“Limited health literacy has been found to be common among patients with Type 2 diabetes and has been shown to be a barrier to adequate self-management of medication regimens, with less comprehension of medication instructions, dosing, timing, and warnings, which could lead to increased risk for hypoglycemia,” say Urmimala Sarkar (University of California, San Francisco, USA) and colleagues.

They therefore investigated the influence of health literacy, determined using a questionnaire asking patients to report non-vision problems with reading, understanding, and filling out forms, on frequency of significant (losing consciousness or needing assistance from others) hypoglycemia in patients with Type 2 diabetes.

In total, 14,357 adults with pharmacologically treated Type 2 diabetes were enrolled in the Diabetes Study of Northern California (DISTANCE). They were asked to report frequency of significant hypoglycemia in the previous 12 months and complete the health literacy questionnaire.

At least one significant hypoglycemic event in the previous 12 months was reported by 11% of the participants. Around 59% of the cohort were taking insulin and this subgroup was at highest risk for significant hypoglycemia.

A high percentage of people were considered to have limited health literacy. More specifically, 53% had problems learning about health, 40% needed help reading health-related materials, and 32% were not confident filling out medical forms by themselves.

Following adjustment for factors such as age, gender, ethnicity, English proficiency, medication type, diabetes duration, and glycated hemoglobin, patients with learning problems were 40% more likely to experience significant hypoglycemia than those without.

Similarly, participants who needed help reading and those who were not confident filling out forms were 30% more likely to experience significant hypoglycemia than their counterparts who did not have these problems.

“Among ambulatory Type 2 diabetes patients receiving care in a well-integrated, managed-care system, we found that hypoglycemia is a significant problem,” write the authors in the Journal of General Internal Medicine.

“Efforts to reduce hypoglycemia and promote patient safety may require self-management support that is appropriate for those with limited health literacy, and to consider more vigilant surveillance, conservative glycemic targets or avoidance of the most hypoglycemia-inducing medications.”

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Helen Albert