Abstract
BackgroundLow health literacy is associated with worse glycemic control among patients with diabetes; the relationship between health literacy and blood glucose among patients without diagnosed diabetes, particularly in resource-limited settings, is not known. Because emergency department patients are at risk for both low health literacy and undiagnosed diabetes, we examined their relationships among emergency department patients at the Georgetown Public Hospital Corporation in Guyana.MethodsWe conducted a cross-sectional study across random time blocks from May to August 2012 among Guyanese emergency department patients without a diagnosis of diabetes. Health literacy was assessed by the Single Item Literacy Screener (SILS, range 1-5); low health literacy was defined as SILS ≥ 3. We examined the relationships among health literacy, random blood glucose (RBG), and point-of-care glycated hemoglobin (HbA1c).ResultsOf the 228 enrolled patients, 125 (54%) were female, median age was 43 years (interquartile range 38 to 53), mean body mass index (BMI) was 25.6 kg/m2 (standard deviation 6.8 kg/m2), and 103 (45.2%) had low health literacy. The receiver operating characteristic area under the curve for RBG to detect elevated HbA1c (≥48mmol/mol) was 0.94 (95% CI: 0.91-0.97). After adjustment for age, sex, BMI, ethnicity, and education, the odds of having HbA1c ≥ 48 mmol/mol, consistent with undiagnosed diabetes, rose with decreasing health literacy (OR 2.2, 95% CI 1.2-3.8, p = 0.007, per point decrease in literacy).ConclusionThis pilot study of Guyanese emergency department patients without diagnosed diabetes found that low health literacy was common and was associated with higher HbA1c and random blood glucose.
Highlights
Low health literacy is associated with worse glycemic control among patients with diabetes; the relationship between health literacy and blood glucose among patients without diagnosed diabetes, in resource-limited settings, is not known
Using a crosssectional convenience sample of patients without a prior history of diabetes who sought medical care in an emergency department in Guyana, we explored the relationship between patient-reported health literacy and blood glucose, as measured by random blood glucose (RBG) and point-of-care (POC) testing of glycated A1c (HbA1c), hypothesizing that low health literacy would be associated with higher RBG and Testing of glycated A1c (HbA1c)
228 patients were included in the analysis evaluating the relationship between health literacy and RBG, and 220 participants were included in the analysis of the relationships among health literacy, RBG, and HbA1c
Summary
From May 21, 2012 to August 7, 2012, we conducted a cross-sectional study of patients who sought medical care at the Georgetown Public Hospital Corporation (GPHC) emergency department in Georgetown, Co-operative Republic of Guyana. Patients triaged as level 2 (urgent) or level 3 (non-urgent) who were considered by the research assistants to be medically or psychologically unstable for participation in the study (e.g. sexual assault, severe pain, heavily intoxicated, active bleeding) were excluded. Those referred for a high blood sugar and those receiving glucose containing intravenous fluids on arrival were excluded. In order to determine whether RBG can be used to detect HbA1c, we fitted a logistic regression model with covariates stated above and created a receiver operating characteristic and estimated the area under the curve (ROC AUC) with its corresponding 95% CI, as well as the sensitivity and specificity at each RBG value
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