Elisabeth den Brok1, Nefeli Dimitropoulou1, Marleen van Greevenbroek1, Cassy Dingena1, Bastiaan de Galan1 on behalf of the MELISSA consortium
1CARIM Cardiovascular Research Institute Maastricht, Maastricht University, the Netherlands
lisa.denbrok@maastrichtuniversity.nl
Background: Despite recent advances in diabetes treatment, many individuals with insulin-treated diabetes continue to face challenges in achieving the recommended glycaemic targets. Effective self-management requires adequate health literacy, numeracy, and increasingly, digital literacy due to the integration of advanced digital tools in diabetes care. Sparse information exists on the level of health literacy in the current technology era.
Methods: The EDUCATE-study is an ongoing European study recruiting 209 adults with type 1, 2, or 3c diabetes on intensive insulin regimens from outpatient clinics in the Netherlands, Denmark, Greece, and Germany. Participants are asked to complete questionnaires, record meals using goFOODTMLite, and wear a physical activity tracker (activPAL4TM) and a blinded glucose monitor (Dexcom G7) for two weeks. The primary outcome is health literacy assessed using the Health Literacy Questionnaire (HLQ); numeracy is evaluated using the diabetes numeracy test (DNT-15).
Results: Data from the first 18 participants in the Netherlands (61% male, median age 64 years (IQR 44–75), 56% type 1 diabetes, median diabetes duration 16 years (IQR 10–34), median HbA1c 63 (IQR 50-71), and 94% using glucose sensors, revealed limited health literacy on several domains of the HLQ. For instance, the means for “HLQ4:Social support for health”, “HLQ5:Appraisal of health information”, and “HLQ7:Navigating the healthcare system” were 2.7±0.6, 2.9±0.4, and 3.5±0.5, respectively. 28% and 11% scored ≤2.5 for HLQ4 and HLQ5, and 50% ≤3.5 for HLQ7, cut-offs for feeling unsupported, overwhelmed, and disempowered in healthcare. The median score on the DNT-15 was 11 (IQR 7–13), with 33% scoring below 10, indicating inadequate numeracy. Common errors included miscalculating carbohydrate intake and medication doses. Strikingly, people with inadequate numeracy often self-report higher scores on specific HLQ-scales than those with high numeracy.
Discussion/Conclusion: These findings suggest that limited health literacy and numeracy is common among Dutch adults with diabetes on intensive insulin treatment, even with sophisticated technological support.