Glycemic Control in Pediatric Type 1 Diabetes: Role of Caregiver Literacy

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Abstract
OBJECTIVE: Poorly controlled diabetes may occur because caregivers of children with type 1 diabetes fail to comprehend provided diabetes education. We hypothesized that poorly controlled diabetes is associated with lower literacy/numerical skills of caregivers of children with type 1 diabetes. METHODS: Primary caregivers were evaluated by using Newest Vital Sign (NVS) and a sociodemographic questionnaire. The NVS identifies individuals who are at risk for low health literacy by measuring general literacy/numeracy skills and yields an overall estimate of health literacy. The NVS scores are interpreted to suggest inadequate, limited, or adequate literacy. RESULTS: Two hundred caregivers of children who had type 1 diabetes with mean hemoglobin A1c (HbA1c) of 8.8 ± 1.9%, age of 11.8 ± 3.7 years, duration of disease of 4.8 ± 3.3 years, and BMI of 20.8 ± 4.4 kg/m2 participated. HbA1c in those of inadequate literacy (10.4 ± 2.2%) was significantly higher than in those of adequate literacy (8.6 ± 1.7%; P < .001). HbA1c in those whose caregivers had limited literacy (9.5 ± 2.2%) did not differ significantly from the other 2 groups. On adjusting for independent covariates, we found that children whose caregivers had at least 50% correct math answers had better glycemic control (8.5 ± 1.7%) than those who failed (9.8 ± 2.1%; P < .0005). CONCLUSIONS: Literacy and numerical skills of caregivers significantly influence glycemic control of their children with type 1 diabetes. Assessing literacy/numeracy skills of caregivers and addressing these deficiencies may be crucial in optimizing glycemic control.