Optimizing Diabetes Self-care in Low Literacy and Minority Populations—Problem-solving, Empowerment, Peer Support and Technology-based Approaches

Abstract

Improved glycemic control among patients with type 2 diabetes has been shown to reduce excess morbidity and mortality. 1 Daily behaviors and activities (diet, physical activity, blood glucose monitoring, foot care, and medication adherence) are key components in maintaining good glycemic control and are therefore critical for effective diabetes management. Patient-level factors have been shown to account for up to 95% of the variance in glycemic control. 2 As such, great emphasis has been placed on implementing behavioral interventions targeting diabetes selfmanagement (DSM) education and skills, particularly among ethnic minority and low-income populations that bear a disproportionate burden of diabetes and have poorer glycemic control. 1 In this issue of the journal, Hill-Briggs et al. 3 examined the feasibility, acceptability, and effectiveness of a problem-based, DSM training adapted for low literacy populations on glycemic control.TheyshowedasignificantchangeinhemoglobinA1cthat wasdiminishedbycontrollingforpatient’sproblem-solvingskills, suggesting that problem solving is a key component for glycemic control. Problem solving coupled with diabetes education for improved knowledge boosts behavior change as it confers more effective coping 4 ;h owever, DSM often requires multiple concurrent and consecutive behavior adjustments that can be overwhelmingly difficult to learn and to maintain for patients with diabetes. The article is interesting and clinically relevant; however, problem solving is one of several strategies to optimize diabetes control in low literacy and minority populations. Although teaching problem-solving skills to individuals with diabetes is an important component of DSM, self-efficacy, empowerment, and social support 5–8 are also critical for them to achieve balance in managing their daily lives and understand how improvements in diabetes management behaviors can be sustained. Improving clinical outcomes for low literacy and minority populations is challenging and requires a multi-pronged approach. It is important to note that tailoring an intervention for low literacy populations may not be as effective as building an intervention specific for populations with low health literacy. Health literacy, distinct from educational attainment,