Health illiteracy and type 2 diabetes mellitus patients

Article Review

Health illiteracy has a significant impact on type 2 diabetes mellitus patients. A study that was done by Koonce et al. (2015) involving 160 participants aimed to determine whether health literacy levels and learning styles impacted positively on the knowledge concerning their condition. The participants were divided randomly into an intervention group (81) and a control group (79) in a healthcare setting. Diabetes Knowledge tests (DKT) containing 23 questions each were administered to both groups. Although 5 patients from the control group and 6 from the intervention group did not finish the study, the remaining 128 made it to the end. Participants in the intervention group (79%) showed more health literacy than those in the control group (66%). More so, participants in the intervention group scored higher on DKT questions than those in the control group. As such, the study confirmed that patients’ knowledge about diabetes increased after exposure to educational materials.

Mikhael,Hassali, & Hussain (2020) conducted a study to determine the effectiveness of Diabetes Self-Management Educational Programs (DSMEP) for type 2 diabetes mellitus patients in the Middle East. Previous studies on the same topic were researched from PubMed and Google Scholar, and twelve of them were selected based on their relevance. Cochrane Risk of Bias Tool was used to assess for any risk of the selected studies. Changes in clinical outcomes after DSMEwere assessed through the calculation of the percentage of DSME studies that led to positive clinical outcomes. Also, the absolute effect in clinical outcomes was observed to determine the effectiveness of the DSME. Analysis of the findings showed that all clinical glycemic outcomes and body mass index were improved in the intervention group as compared to the control group in at least 60% of the included studies. All patients reported that DSME programs improved their outcomes.

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Carole et al. (2015) as well conducted a study to determine diabetic self-management education (DSME) on glycemic control in type 2 diabetes patients. Previous studies were searched from peer-reviewed sources such as Medline and PsychINFO, among others. Analysis of the selected studies showed that 61.9% of the participants showed a change in glycemic levels after undergoing DSME. The overall mean reduction in the glycemic levels 0.74 in the intervention group and 0.17 in the control group. The mean average absolute reduction was 0.57. This showed that engaging in DSME resulted in a decrease in glycemic levels.

Al-Shahrani (2018) did research at a diabetic and endocrine center in Saudi Arabia to determine the effect of diabetic health education on glycemic control in type 2diabetic patients. Epi Info version was used to sample 465 participants out of 4100. Personal and demographic data were collected before the participants underwent 30 minutes diabetic education program every two months for one year. Two blood samples were taken from each participant during the program to determine changes in glycemic levels. There was a decrease in the mean glycemic levels after the successful completion of the diabetic education program from 10.41 to 8.22.

In 2016, Fitzgerald, Funnell, &Anderson carried out research to determine the reliability and validity of the revised Diabetic Knowledge Test (DKT). Two samples, one containing 101 participants from an online survey company (Qualtrics) and the other containing 89 participants from the University of Michigan diabetic registry (MEND), were selected. A comparison in education levels, glycemic levels, type of diabetes, and the type of insulin and oral medications used was done to confirm the validity. Analysis of the results showed that the mean of the MEND test score was higher than that of Qualtrics. As such, the study showed that the effectiveness of the revised DKT depended on the objective of the physician taking care of the patient.

Technology-enabled diabetes self-management education and support (DSMES) has an outstanding impact on diabetic patients. A study conducted by Greenwood, Gee, Fatkin, & Peeples(2017) was aimed to prove the effectiveness of the approach. A systematic review of twenty-five peer-reviewed articles was done. Eighteen of the reviewed articles showed a reduction in glycemic levels in people who applied technology-enabled DSMES. The results also showed that technology-enabled DSMES enhanced communication, education, and instant feedback, which made this approach effective in reducing glycemic levels.

Santorelli,Ekanayake, & Wilkerson-Leconte (2017) carried out research to investigate the rate of participation of adult patients in diabetic self-management classes.Behavioral Risk Factor Surveillance System (BRFSS) was used to collect data. A total of 4358 participants were selected, and a SAS version 9.2 complex survey procedure was followed. More so, the Rao Scott χ2 test was used to validate annual estimates for diabetes prevalence in New Jersey. Results showed that the annual New Jersey response rate had risen from 41.4% in 2013 to 46.6% in 2015. Although the rate of participation had increased, patient participation varied in different counties based on factors such as education levels and race.

In summary, diabetic self-management education programs have a great impact when utilized by type 2 diabetic patients. Based on the information from the reviewed articles, patients who had participated in DSME programs showed a decrease in glycemic levels as compared to those who rarely participated. Also, the articles show that participation in DSME programs varied depending on the level of education, race, and illiteracy. More so, technology-enabled diabetes self-management education and support programs produced great results in glycemic levels as patients found it more convenient to study health materials on the phones and computers than attend actual DSME programs.


Al-Shahrani, A. M. (2018). Impact of health education program on diabetic control among diabetic patients managed at a diabetic and endocrine center in Bisha, Saudi Arabia.

Chrvala, C. A., Sherr, D., & Lipman, R. D. (2016). Diabetes self-management education for adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic control. Patient education and counseling99(6), 926-943.

Fitzgerald, J. T., Funnell, M. M., Anderson, R. M., Nwankwo, R., Stansfield, R. B., &Piatt, G. A. (2016). Validation of the revised brief diabetes knowledge test (DKT2). The Diabetes Educator42(2), 178-187.

Greenwood, D. A., Gee, P. M., Fatkin, K. J., & Peeples, M. (2017). A systematic review of reviews evaluating technology-enabled diabetes self-management education and support. Journal of diabetes science and technology11(5), 1015-1027.

Koonce, T. Y., Giuse, N. B., Kusnoor, S. V., Hurley, S., & Ye, F. (2015). A personalized approach to deliver health care information to diabetic patients in community care clinics. Journal of the Medical Library Association: JMLA103(3), 123.

Mikhael, E. M., Hassali, M. A., & Hussain, S. A. (2020). Effectiveness of Diabetes Self-Management Educational Programs For Type 2 Diabetes Mellitus Patients In Middle East Countries: A Systematic Review. Diabetes, Metabolic Syndrome, and Obesity: Targets and Therapy13, 117.

Santorelli, M. L., Ekanayake, R. M., & Wilkerson-Leconte, L. (2017). Peer-Reviewed: Participation in a Diabetes Self-Management Class Among Adults With Diabetes, New Jersey 2013–2015. Preventing chronic disease14.


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