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Latest List of Best Diabetes Dissertation Topics
Published by Owen Ingram at January 2nd, 2023 , Revised On May 17, 2024
The prevalence of diabetes among the world’s population has been increasing steadily over the last few decades, thanks to the growing consumption of fast food and an increasingly comfortable lifestyle. With the field of diabetes evolving rapidly, it is essential to base your dissertation on a trending diabetes dissertation topic that fills a gap in research.
Finding a perfect research topic is one of the most challenging aspects of dissertation writing in any discipline . Several resources are available to students on the internet to help them conduct research and brainstorm to develop their topic selection, but this can take a significant amount of time. So, we decided to provide a list of well-researched, unique and intriguing diabetes research topics and ideas to help you get started.
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List of Diabetes Dissertation Topics
- Why do people recently diagnosed with diabetes have such difficulty accepting reality and controlling their health?
- What are the reactions of children who have recently been diagnosed with diabetes? What can be done to improve their grasp of how to treat the disease?
- In long-term research, people getting intensive therapy for the condition had a worse quality of life. What role should health professionals have in mitigating this effect?
- Why do so many individuals experience severe depression the months after their diagnosis despite displaying no other signs of deteriorating health?
- Discuss some of the advantages of a low-carbohydrate, high-fat diet for people with diabetes
- Discuss the notion of diabetes in paediatrics and why it is necessary to do this research regularly.
- Explain the current threat and difficulty of childhood obesity and diabetes, stressing some areas where parents are failing in their position as guardians to avoid the situation
- Explain some of the difficulties that persons with diabetes have, particularly when obtaining the necessary information and medical treatment
- Explain some of the most frequent problems that people with diabetes face, as well as how they affect the prevalence of the disease. Put out steps that can be implemented to help the problem.
- Discuss the diabetes problem among Asian American teens
- Even though it is a worldwide disease, particular ethnic groups are more likely to be diagnosed as a function of nutrition and culture. What can be done to improve their health literacy?
- Explain how self-management may be beneficial in coping with diabetes, particularly for people unable to get prompt treatment for their illness
- Discuss the possibility of better management for those with diabetes who are hospitalised
- What current therapies have had the most influence on reducing the number of short-term problems in patients’ bodies?
- How have various types of steroids altered the way the body responds in people with hypoglycemia more frequently than usual?
- What effects do type 1, and type 2 diabetes have on the kidneys? How do the most widely used monitoring approaches influence this?
- Is it true that people from specific ethnic groups are more likely to acquire heart disease or eye illness due to their diabetes diagnosis?
- How has the new a1c test helped to reduce the detrimental consequences of diabetes on the body by detecting the condition early?
- Explain the difficulty of uncontrolled diabetes and how it can eventually harm the kidneys and the heart
- Discuss how the diabetic genetic strain may be handed down from generation to generation
- What difficulties do diabetic people have while attempting to check their glucose levels and keep a balanced food plan?
- How have some individuals with type 1 or type 2 diabetes managed to live better lives than others with the disease?
- Is it true that eating too much sugar causes diabetes, cavities, acne, hyperactivity, and weight gain?
- What effect does insulin treatment have on type 2 diabetes?
- How does diabetes contribute to depression?
- What impact does snap participation have on diabetes rates?
- Why has the number of persons who perform blood glucose self-tests decreased? Could other variables, such as social or environmental, have contributed to this decrease?
- Why do patients in the United States struggle to obtain the treatment they require to monitor and maintain appropriate glucose levels? Is this due to increased healthcare costs?
- Nutrition is critical to a healthy lifestyle, yet many diabetic patients are unaware of what they should consume. Discuss
- Why have injuries and diabetes been designated as national health priorities?
- What factors contribute to the growing prevalence of type II diabetes in adolescents?
- Does socioeconomic status influence the prevalence of diabetes?
- Alzheimer’s disease and type 2 diabetes: a critical assessment of the shared pathological traits
- What are the effects and consequences of diabetes on peripheral blood vessels?
- What is the link between genetic predisposition, obesity, and type 2 diabetes development?
- Diabetes modifies the activation and repression of pro- and anti-inflammatory signalling pathways in the vascular system.
- Understanding autoimmune diabetes through the tri-molecular complex prism
- Does economic status influence the regional variation of diabetes caused by malnutrition?
- What evidence is there for using traditional Chinese medicine and natural products to treat depression in people who also have diabetes?
- Why was the qualitative method used to evaluate diabetes programs?
- Investigate the most common symptoms of undiagnosed diabetes
- How can artificial intelligence help diabetes patients?
- What effect does the palaeolithic diet have on type 2 diabetes?
- What are the most common causes of diabetes and what are the treatments?
- What causes diabetes mellitus, and how does it affect the United Kingdom?
- The impact of sociodemographic factors on the development of type II diabetes
- An examination of the link between gut microbiome and diabetes risk
- The effectiveness of lifestyle interventions in preventing type II diabetes
- The role of maternal diabetes in offspring’s risk of developing diabetes
- Artificial intelligence in diabetes diagnosis and management
- Continuous glucose monitoring
- Telehealth interventions for improving diabetes self-management
- The role of wearable technology in diabetes management
- Personalised medicine approaches for diabetes treatment
- The impact of diabetes on mental health and well-being
- The link between diabetes and cognitive decline
- The potential of stem cell therapy for diabetes treatment
- Advances in closed-loop insulin delivery systems
- The use of glucagon-like peptide-1 (GLP-1) receptor agonists in diabetes treatment
- Investigating the efficacy of new oral medications for type II diabetes
- The role of bariatric surgery in the management of type II diabetes
- Improving patient adherence to diabetes treatment regimens
- The role of social support in diabetes management
- Developing culturally sensitive diabetes education programs
- The role of dietary patterns in diabetes prevention and management
- Low-carbohydrate vs. Mediterranean diet for diabetes: A comparative study
- The use of artificial sweeteners in diabetes management: Benefits and risks
- The impact of the gut microbiome on dietary interventions for diabetes
- The role of exercise in improving glycemic control
- Developing effective exercise programs for individuals with diabetes
- The impact of physical activity on diabetic complications
- Promoting physical activity adherence in people with diabetes
- The use of exercise gamification to increase physical activity in diabetes
- The potential of CRISPR gene editing for diabetes treatment
- The role of the microbiome in the development and treatment of diabetes
- An analysis of the artificial Pancreas systems
- The use of big data analytics in diabetes research
- The impact of environmental factors on diabetes risk
- Cost-effectiveness of different diabetes treatment strategies
- Developing effective diabetes prevention programs for communities
- The role of government policies in addressing the diabetes epidemic
- Improving access to diabetes care in underserved populations
- The impact of social determinants of health on diabetes risk
- Management of diabetes in children and adolescents
- The unique challenges of diabetes management in older adults
- Diabetes in ethnic minorities: Disparities in prevalence and care
- The impact of diabetes on LGBTQ+ populations
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Frequently Asked Questions
How to find diabetes dissertation topics.
To find diabetes dissertation topics:
- Study recent research in diabetes.
- Focus on emerging trends.
- Explore prevention, treatment, tech, etc.
- Consider cultural or demographic aspects.
- Consult experts or professors.
- Select a niche that resonates with you.
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357 Diabetes Essay Topics & Examples
When you write about the science behind nutrition, heart diseases, and alternative medicine, checking titles for diabetes research papers can be quite beneficial. Below, our experts have gathered original ideas and examples for the task.
🏆 Best Diabetes Essay Examples & Topics
⭐ most interesting diabetes research paper topics, ✅ simple & easy diabetes essay topics, 🎓 good research topics about diabetes, 💡 interesting topics to write about diabetes, 👍 good essay topics on diabetes, ❓ diabetes research question examples.
- Living with a Chronic Disease: Diabetes and Asthma This paper will look at the main effects of chronic diseases in the lifestyle of the individuals and analyze the causes and the preventive measures of diabetes as a chronic disease.
- Diabetes Mellitus: Symptoms, Types, Effects Insulin is the hormone that controls the levels of glucose in the blood, and when the pancreas releases it, immediately the high levels are controlled, like after a meal.
- Leadership in Diabetes Management Nurses can collaborate and apply evidence-based strategies to empower their diabetic patients. The involvement of all key stakeholders is also necessary.
- Adult-Onset Type 2 Diabetes: Patient’s Profile Any immediate care as well as post-discharge treatment should be explained in the best manner possible that is accessible and understandable to the patient.
- Type 2 Diabetes as a Public Health Issue In recent years, a steady increase in the incidence and prevalence of diabetes is observed in almost all countries of the world.
- Gestational Diabetes: Child Bearing Experience Insulin resistance in GDM is likely to be the result of a combination of lifestyle factors and the insulin-desensitizing effect of chorionic gonadotrophins.
- Nursing Care Development Plan for Diabetes and Hypertension In addressing the first nursing diagnosis, the main aim of the nursing interventions will be to prevent the development of secondary hypoglycemia by increasing blood glucose levels.
- Diabetes Management and Evidence-Based Practice Diabetes is a state of glucose intolerance that requires the management of blood glucose. Good glycemic control ensures that the level of glucose in a diabetic patient is maintained at levels similar to that of […]
- Nursing Diagnosis: Type 1 Diabetes & Hypertension The nursing diagnosis based on the identified and primary problems are, “Risk for injury related to hypoglycemia, ‘Risk for Unstable blood glucose level related to lack of adequate management of hypoglycemia evidenced by decreased blood […]
- Disease Management for Diabetes Mellitus The selection of the appropriate philosophical and theoretical basis for the lesson is essential as it allows for the use of an evidence-based method for learning about a particular disease.
- Case Study of Patient with DKA and Diabetes Mellitus It is manifested by a sharp increase in glucose levels and the concentration of ketone bodies in the blood, their appearance in the urine, regardless of the degree of violation of the patient’s consciousness.
- Health Nursing and Managing Diabetes The practice will equip more patients with the best ideas and initiatives to deal with diabetes. The completed study will provide the best practices and evidence-based ideas to help patients with diabetes type II.
- Diabetes: Symptoms, Treatment, and Prevention As a consequence, the amount of sugar in the blood is made to rise and this cause discomfort for the affected individuals.
- Diabetes Mellitus: Types, Causes, Presentation, Treatment, and Examination Diabetes mellitus is a chronic endocrinologic disease, which is characterized by increased blood glucose concentration.
- The Nature of Type 1 Diabetes Mellitus Type 1 diabetes mellitus is a chronic autoimmune disease that has an active genetic component, which is identified by increased blood glucose levels, also known as hyperglycemia.
- Counseling and Education Session in Type II Diabetes Patients will be educated about the glycemic index and its effect on their blood sugar Patients will learn to count their carbohydrates. Patients will set up their goal and the timeframe to achieve it.
- Gestational Diabetes in a 38-Year-Old Woman The concept map, created to meet B.’s needs, considers her educational requirements and cultural and racial hurdles to recognize her risk factors and interventions to increase her adherence to the recommended course of treatment.B.said in […]
- Type 2 Diabetes Mellitus and Its Implications You call an ambulance and she is taken in to the ED. Background: Jean is still very active and works on the farm 3 days a week.
- Development of Comprehensive Inpatient and Outpatient Programs for Diabetes Overcoming the fiscal and resource utilization issues in the development of a comprehensive diabetes program is essential for the improvement of health and the reduction of treatment costs.
- Healthcare Cost Depending on Chronic Disease Management of Diabetes and Hypertension A sufficient level of process optimization and the presence of a professional treating staff in the necessary number will be able to help improve the indicators.
- Improving Glycemic Control in Black Patients with Type 2 Diabetes Information in them is critical for answering the question and supporting them with the data that might help to acquire an enhanced understanding of the issue under research. Finally, answering the PICOT question, it is […]
- Shared Decision-Making That Affects the Management of Diabetes The article by Peek et al.is a qualitative study investigating the phenomenon of shared decision-making that affects the management of diabetes. The researchers demonstrate the racial disparity that can arise in the choice of approaches […]
- Managing Obesity as a Strategy for Addressing Type 2 Diabetes When a patient, as in the case of Amanda, requires a quick solution to the existing problem, it is necessary to effectively evaluate all options in the shortest possible time.
- Tests and Screenings: Diabetes and Chronic Kidney Disease The test is offered to patients regardless of gender, while the age category is usually above 45 years. CDC1 recommends doing the test regardless of gender and is conducted once or twice to check the […]
- Obesity Management for the Treatment of Type 2 Diabetes American Diabetes Association states that for overweight and obese individuals with type 2 diabetes who are ready to lose weight, a 5% weight reduction diet, physical exercise, and behavioral counseling should be provided.
- COVID-19 and Diabetes Mellitus Lim et al, in their article, “COVID-19 and diabetes mellitus: from pathophysiology to clinical management”, explored how COVID-19 can worsen the symptoms of diabetes mellitus.
- The Importance of Physical Exercise in Diabetes II Patients The various activities help to improve blood sugar levels, reduce cardiovascular cases and promote the overall immunity of the patient. Subsequently, the aerobic part will help to promote muscle development and strengthen the bones.
- Diabetes Education Workflow Process Mapping DSN also introduces the patient to the roles of specialists involved in managing the condition, describes the patient’s actions, and offers the necessary educational materials.
- Diabetes: Treatment Complications and Adjustments One of the doctor’s main priorities is to check the compatibility of a patient’s medications. The prescriptions of other doctors need to be thoroughly checked and, if necessary, replaced with more appropriate medication.
- The Type 2 Diabetes Mellitus PICOT (Evidence-Based) Project Blood glucose levels, A1C, weight, and stress management are the parameters to indicate the adequacy of physical exercise in managing T2DM.
- Chronic Disease Cost Calculator (Diabetes) This paper aims at a thorough, detailed, and exhaustive explanation of such a chronic disease as diabetes in terms of the prevalence and cost of treatment in the United States and Maryland.
- Diabetes Mellitus Epidemiology Statistics This study entails a standard established observation order from the established starting time to an endpoint, in this case, the onset of disease, death, or the study’s end. It is crucial to state this value […]
- Epidemiology: Type II Diabetes in Hispanic Americans The prevalence of type II diabetes in Hispanic Americans is well-established, and the search for inexpensive prevention methods is in the limelight.
- Diabetes: Risk Factors and Effects Trends in improved medical care and the development of technology and medicine are certainly contributing to the reduction of the problem. All of the above indicates the seriousness of the problem of diabetes and insufficient […]
- Barriers to Engagement in Collaborative Care Treatment of Uncontrolled Diabetes The primary role of physicians, nurses, and other healthcare team members is to provide patients with medical treatment and coordinate that care while also working to keep costs down and expand access.
- Hereditary Diabetes Prevention With Lifestyle Modification Yeast infections between the fingers and toes, beneath the breast, and in or around the genital organs are the common symptoms of type 2 diabetes.
- Health Equity Regarding Type 2 Diabetes According to Tajkarimi, the number of research reports focusing on T2D’s prevalence and characteristics in underserved minorities in the U. Adapting the program’s toolkits to rural Americans’ eating and self-management habits could also be instrumental […]
- Diabetes Mellitus: Treatment Methods Moreover, according to the multiple findings conducted by Park et al, Billeter et al, and Tsilingiris et al, bariatric surgeries have a positive rate of sending diabetes into remission.
- Diagnosing Patient with Insulin-Dependent Diabetes The possible outcomes of the issues that can be achieved are discussing the violations with the patient’s family and convincing them to follow the medical regulations; convincing the girl’s family to leave her at the […]
- Human Service for Diabetes in Late Adulthood The mission of the Georgia Diabetic Foot Care Program is to make a positive difference in the health of persons living with diabetes.
- Diabetes: Symptoms and Risk Factors In terms of the problem, according to estimates, 415 million individuals worldwide had diabetes mellitus in 2015, and it is expected to rise to 642 million by the year 2040.
- Diabetes: Types and Management Diabetes is one of the most prevalent diseases in the United States caused when the body fails to optimally metabolize food into energy.
- Epidemiology of Diabetes and Forecasted Trends The authors note that urbanization and the rapid development of economies of different countries are the main causes of diabetes. The authors warn that current diabetes strategies are not effective since the rate of the […]
- The Aboriginal Diabetes Initiative in Canada The ADI’s goal in the CDS was to raise type 2 diabetes awareness and lower the incidence of associated consequences among Aboriginal people.
- Communicating the Issue of Diabetes The example with a CGM sensor is meant to show that doctors should focus on educating people with diabetes on how to manage their condition and what to do in extreme situations.
- Obesity and Diabetes Mellitus Type 2 The goal is to define the features of patient information to provide data on the general course of the illness and its manifestations following the criteria of age, sex, BMI, and experimental data.
- The Prevention of Diabetes and Its Consequences on the Population At the same time, these findings can also be included in educational programs for people living with diabetes to warn them of the risks of fractures and prevent them.
- Uncontrolled Type 2 Diabetes and Depression Treatment The data synthesis demonstrates that carefully chosen depression and anxiety treatment is likely to result in better A1C outcomes for the patient on the condition that the treatment is regular and convenient for the patients.
- Type 2 Diabetes: Prevention and Education Schillinger et al.came to the same conclusion; thus, their findings on the study of the Bigger Picture campaign effectiveness among youth of color are necessary to explore diabetes prevention.
- A Diabetes Quantitative Article Analysis The article “Correlates of accelerometer-assessed physical activity and sedentary time among adults with type 2 diabetes” by Mathe et al.refers to the global issue of the prevention of diabetes and its complications.
- A Type 2 Diabetes Quantitative Article Critique Therefore, the main issue is the prevention of type 2 diabetes and its consequences, and this paper will examine one of the scientific studies that will be used for its exploration.
- The Diabetes Prevention Articles by Ford and Mathe The main goal of the researchers was to measure the baseline MVPA of participants and increase their activity to the recommended 150 minutes per week through their participation in the Diabetes Community Lifestyle Improvement Program.
- Type 2 Diabetes in Hispanic Americans The HP2020 objectives and the “who, where, and when” of the problem highlight the significance of developing new, focused, culturally sensitive T2D prevention programs for Hispanic Americans.
- Diabetes Mellitus as Problem in US Healthcare Simultaneously, insurance companies are interested in decreasing the incidence of diabetes to reduce the costs of testing, treatment, and provision of medicines.
- Diabetes Prevention as a Change Project All of these queries are relevant and demonstrate the importance of including people at high risk of acquiring diabetes in the intervention.
- Evidence Synthesis Assignment: Prevention of Diabetes and Its Complications The purpose of this research is to analyze and synthesize evidence of good quality from three quantitative research and three non-research sources to present the problem of diabetes and justify the intervention to address it.
- Diabetes Mellitus: Causes and Health Challenges Second, the nature of this problem is a clear indication of other medical concerns in this country, such as poor health objectives and strategies and absence of resources.
- Diabetes in Adults in Oxfordshire On a national level, Diabetes Research and Wellness Foundation aims to prevent the spread of the decease through research of the causes and effective treatment of diabetes 2 type.
- Diabetes Mellitus (DM) Disorder Case Study Analysis Thus, informing the patient about the importance of regular medication intake, physical activity, and adherence to diet in maintaining diabetes can solve the problem.
- Diabetes Mellitus in Young Adults Thus, programs for young adults should predominantly focus on the features of the transition from adolescence to adulthood. As a consequence, educational programs on diabetes improve the physical and psychological health of young adults.
- A Healthcare Issue of Diabetes Mellitus Diabetes mellitus is seen as a primary healthcare issue that affects populations across the globe and necessitates the combination of a healthy lifestyle and medication to improve the quality of life of people who suffer […]
- Control of LDL Cholesterol Levels in Patients, Gestational Diabetes Mellitus In addition, some patients with hypercholesterolemia may have statin intolerance, which reduces adherence to therapy, limits treatment efficacy, and increases the risk of CVD.
- Exploring Glucose Tolerance and Gestational Diabetes Mellitus In the case of a glucose tolerance test for the purpose of diagnosing GDM type, the interpretation of the test results is carried out according to the norms for the overall population.
- Type 2 Diabetes Health Issue and Exercise This approach will motivate the patient to engage in exercise and achieve better results while reducing the risk of diabetes-related complications.
- Diabetes Interventions in Children The study aims to answer the PICOT Question: In children with obesity, how does the use of m-Health applications for controlling their dieting choices compare to the supervision of their parents affect children’s understanding of […]
- Diabetes Tracker Device and Its Advantages The proposed diabetes tracker is a device that combines the functionality of an electronic BGL tester and a personal assistant to help patients stick to their diet plan.
- Latino People and Type 2 Diabetes The primary aim of the study is to determine the facilitators and barriers to investigating the decision-making process in the Latin population and their values associated with type 2 diabetes.
- Diabetes Self-Management Education and Support Program The choice of this topic and question is based on the fact that despite the high prevalence of diabetes among adolescents in the United States, the use of DSMES among DM patients is relatively low, […]
- Diabetes Mellitus Care Coordination The aim is to establish what medical technologies, care coordination and community resources, and standards of nursing practice contribute to the quality of care and safety of patients with diabetes.
- Healthy Lifestyle Interventions in Comorbid Asthma and Diabetes In most research, the weight loss in cases of comorbid asthma and obesity is reached through a combination of dietary interventions and physical exercise programs.
- PDSA in Diabetes Prevention The second step in the “Do” phase would be to isolate a few members of the community who are affected by diabetes voluntarily.
- Diabetes: Statistics, Disparities, Therapies The inability to produce adequate insulin or the body’s resistance to the hormone is the primary cause of diabetes. Diabetes is a serious health condition in the U.S.and the world.
- Type 2 Diabetes Prescriptions and Interventions The disadvantage is the difficulty of obtaining a universal model due to the complexity of many factors that can affect the implementation of recommendations: from the variety of demographic data to the patient’s medical history.
- Health Education for Female African Americans With Diabetes In order to address and inform the public about the challenges, nurses are required to intervene by educating the population on the issues to enhance their understanding of the risks associated with the conditions they […]
- Diabetes Risk Assessment and Prevention It is one of the factors predisposing patients suffering from diabetes to various cardiovascular diseases. With diabetes, it is important to learn how to determine the presence of carbohydrates in foods.
- Diabetes Mellitus: Preventive Measures In addition to addressing the medical specialists who will be of service in disease prevention, it will emphasize the intervention programs required to help control the spread of the illness.
- “The Diabetes Online Community” by Litchman et al. The researchers applied the method of telephone interviews to determine the results and effectiveness of the program. The study described the value of DOC in providing support and knowledge to older diabetes patients.
- Mobile App for Improved Self-Management of Type 2 Diabetes The central focus of the study was to assess the effectiveness of the BlueStar app in controlling glucose levels among the participants.
- Type 2 Diabetes in Minorities from Cultural Perspective The purpose of this paper is to examine the ethical and cultural perspectives on the issue of T2DM in minorities. Level 2: What are the ethical obstacles to treating T2DM in ethnic and cultural minorities?
- Ethics of Type 2 Diabetes Prevalence in Minorities The purpose of this article analysis is to dwell on scholarly evidence that raises the question of ethical and cultural aspects of T2DM prevalence in minorities.
- Type 2 Diabetes in Minorities: Research Questions The Level 2 research questions are: What are the pathophysiological implications of T2DM in minorities? What are the statistical implications of T2DM in minorities?
- Improving Adherence to Diabetes Treatment in Primary Care Settings Additionally, the patients from the intervention group will receive a detailed explanation of the negative consequences of low adherence to diabetes treatment.
- An Advocacy Tool for Diabetes Care in the US To ensure the implementation and consideration of my plea, I sent a copy of the letter to the government officials so it could reach the president.
- Diabetes and Allergies: A Statistical Check The current dataset allowed us to test the OR for the relationship between family history of diabetes and the presence of diabetes in a particular patient: all variables were dichotomous and discrete and could take […]
- Type 2 Diabetes in Adolescents According to a National Diabetes Statistics Report released by the Centers for Disease Control and Prevention, the estimated prevalence of the disease was 25 cases per 10,000 adolescents in 2017. A proper understanding of T2D […]
- Analysis of Diabetes and Its Huge Effects In the US, diabetes is costly to treat and has caused much physical, emotional and mental harm to the people and the families of those who have been affected by the disease.
- Nursing: Self-Management of Type II Diabetes Sandra Fernandes and Shobha Naidu’s journal illustrates the authors’ understanding of a significant topic in the nursing profession.”Promoting Participation in self-care management among patients with diabetes mellitus” article exposes readers to Peplau’s theory to understand […]
- The Impact of Vegan and Vegetarian Diets on Diabetes Vegetarian diets are popular for a variety of reasons; according to the National Health Interview Survey in the United States, about 2% of the population reported following a vegetarian dietary pattern for health reasons in […]
- “Diabetes Prevention in U.S. Hispanic Adults” by McCurley et al. This information allows for supposing that face-to-face interventions can be suitable to my practicum project that considers measures to improve access to care among African Americans with heart failure diseases. Finally, it is possible to […]
- Diabetes Disease of the First and Second Types It is a decrease in the biological response of cells to one or more effects of insulin at its average concentration in the blood. During the first type of diabetes, insulin Degludec is required together […]
- Person-Centered Strategy of Diabetes and Dementia Care The population of focus for this study will be Afro-American women aged between sixty and ninety who have diabetes of the second type and dementia or are likely to develop dementia in the future.
- Video Consultations Between Patients and Clinicians in Diabetes, Cancer, and Heart Failure Services For example, during one of my interactions with the patient, I was asked whether the hospital had the policy to avoid face-to-face interaction during the pandemic with the help of video examinations.
- Diets to Prevent Heart Disease, Cancer, and Diabetes In order to prevent heart disease, cancer, and diabetes, people are required to adhere to strict routines, including in terms of diet. Additionally, people wanting to prevent heart disease, cancer, and diabetes also need to […]
- The Centers for Diabetes’ Risks Assessment In general, the business case for the Centers for Diabetes appears to be positive since the project is closely aligned with the needs of the community and the targets set by the Affordable Care Act.
- Diabetes Management Type 1 and Type 2 diabetes contrast based on their definitions, the causes, and the management of the conditions. Since the CDC promotes the avoidance of saturated fat and the increase of fiber intake for […]
- Intervention Methods for Type 2 Diabetes Mellitus An individual should maintain a regulated glycemic control using the tenets of self-management to reduce the possibility of complications related to diabetes.
- Diabetes Mellitus as Leading Cause of Disability The researchers used data from the Centers for Disease Control and Prevention, where more than 12% of older people in the US live with the condition.
- Depression in Diabetes Patients The presence of depression concomitant to diabetes mellitus prevents the adaptation of the patient and negatively affects the course of the underlying disease.
- The Relationship Between Diabetes and COVID-19 After completing the research and analyzing the articles, it is possible to suggest a best practice that may be helpful and effective in defining the relationship between diabetes and COVID-19 and providing a way to […]
- Pre-diabetes and Urinary Incontinence Most recent reports indicate that a physiotherapy procedure gives a positive result in up to 80% of patients with stage I or SUI and mixed form and 50% of patients with stage II SUI.
- Type 1 Diabetes: Recommendations for Alternative Drug Treatments Then, they have to assess the existing levels of literacy and numeracy a patient has. Tailoring educational initiatives to a person’s unique ethnic and cultural background is the basis of cultural competence in patient education.
- Type 2 Diabetes: A Pharmacologic Update Diabetes presents one of the most common diagnoses in causes of ED visits among adults and one of the leading causes of death in the United States.
- Diabetes: Vulnerability, Resilience, and Care In nursing care, resilience is a critical concept that shows the possibility of a person to continue functioning and meeting objectives despite the existing challenges.
- Diabetes Prevention in the United States The analysis of these policies and the other strategies provides the opportunity to understand what role they might play in the improvement of human health. NDPP policy, on the other hand, emphasizes the role of […]
- Teaching Experience: Diabetes Prevention The primary objective of the seminar is to reduce the annual number of diabetes cases and familiarize the audience with the very first signs of this disease.
- Summary of Type 2 Diabetes: A Pharmacologic Update The authors first emphasize that T2D is one of the most widespread diseases in the United States and the seventh leading cause of death.
- Insulin Effects in a Diabetes Person I will use this source to support my research because the perception of diabetes patients on insulin therapy is essential for understanding the impact they cause on the person.
- Diabetes and Medical Intervention In the research conducted by Moin et al, the authors attempted to define the scope of efficiency of such a tool as an online diabetes prevention program in the prevention of diabetes among obese/overweight population […]
- Relation Between Diabetes And Nutrition Any efforts to lessen and eliminate the risk of developing diabetes must involve the dietary habit of limiting the consumption of carbohydrates, sugar, and fats. According to Belfort-DeAguiar and Dongju, the three factors of obesity, […]
- Diabetes Mellitus Type 2 and a Healthy Lifestyle Relationship The advantage of this study over the first is that the method uses a medical approach to determining the level of fasting glucose, while the dependences in the study of Ugandans were found using a […]
- Diabetes and Its Economic Effect on Healthcare For many years, there has been an active increase in the number of cases of diabetes of all types among the global population, which further aggravates the situation.
- Pathogenesis and Prevention of Diabetes Mellitus and Hypertension The hormone is produced by the cells of the islets of Langerhans found in the pancreas. It is attributed to the variation in the lifestyle of these individuals in these two geographical zones.
- Parental Intervention on Self-Management of an Adolescent With Diabetes Diabetes development and exposure are strongly tied to lifestyle, and the increasing incidents rate emphasizes the severity of the population’s health problem.
- Addressing the Needs of Hispanic Patients With Diabetes Similarly, in the program at hand, the needs of Hispanic patients with diabetes will be considered through the prism of the key specifics of the community, as well as the cultural background of the patients.
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Article information, literature review of type 2 diabetes management and health literacy.
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Rulla Alsaedi , Kimberly McKeirnan; Literature Review of Type 2 Diabetes Management and Health Literacy. Diabetes Spectr 1 November 2021; 34 (4): 399–406. https://doi.org/10.2337/ds21-0014
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The purpose of this literature review was to identify educational approaches addressing low health literacy for people with type 2 diabetes. Low health literacy can lead to poor management of diabetes, low engagement with health care providers, increased hospitalization rates, and higher health care costs. These challenges can be even more profound among minority populations and non-English speakers in the United States.
A literature search and standard data extraction were performed using PubMed, Medline, and EMBASE databases. A total of 1,914 articles were identified, of which 1,858 were excluded based on the inclusion criteria, and 46 were excluded because of a lack of relevance to both diabetes management and health literacy. The remaining 10 articles were reviewed in detail.
Patients, including ethnic minorities and non-English speakers, who are engaged in diabetes education and health literacy improvement initiatives and ongoing follow-up showed significant improvement in A1C, medication adherence, medication knowledge, and treatment satisfaction. Clinicians considering implementing new interventions to address diabetes care for patients with low health literacy can use culturally tailored approaches, consider ways to create materials for different learning styles and in different languages, engage community health workers and pharmacists to help with patient education, use patient-centered medication labels, and engage instructors who share cultural and linguistic similarities with patients to provide educational sessions.
This literature review identified a variety of interventions that had a positive impact on provider-patient communication, medication adherence, and glycemic control by promoting diabetes self-management through educational efforts to address low health literacy.
Diabetes is the seventh leading cause of death in the United States, and 30.3 million Americans, or 9.4% of the U.S. population, are living with diabetes ( 1 , 2 ). For successful management of a complicated condition such as diabetes, health literacy may play an important role. Low health literacy is a well-documented barrier to diabetes management and can lead to poor management of medical conditions, low engagement with health care providers (HCPs), increased hospitalizations, and, consequently, higher health care costs ( 3 – 5 ).
The Healthy People 2010 report ( 6 ) defined health literacy as the “degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Diabetes health literacy also encompasses a wide range of skills, including basic knowledge of the disease state, self-efficacy, glycemic control, and self-care behaviors, which are all important components of diabetes management ( 3 – 5 , 7 ). According to the Institute of Medicine’s Committee on Health Literacy, patients with poor health literacy are twice as likely to have poor glycemic control and were found to be twice as likely to be hospitalized as those with adequate health literacy ( 8 ). Associations between health literacy and health outcomes have been reported in many studies, the first of which was conducted in 1995 in two public hospitals and found that many patients had inadequate health literacy and could not perform the basic reading tasks necessary to understand their treatments and diagnoses ( 9 ).
Evaluation of health literacy is vital to the management and understanding of diabetes. Several tools for assessing health literacy have been evaluated, and the choice of which to use depends on the length of the patient encounter and the desired depth of the assessment. One widely used literacy assessment tool, the Test of Functional Health Literacy in Adults (TOFHLA), consists of 36 comprehension questions and four numeric calculations ( 10 ). Additional tools that assess patients’ reading ability include the Rapid Estimate of Adult Literacy in Medicine (REALM) and the Literacy Assessment for Diabetes. Tests that assess diabetes numeracy skills include the Diabetes Numeracy Test, the Newest Vital Sign (NVS), and the Single-Item Literacy Screener (SILS) ( 11 ).
Rates of both diabetes and low health literacy are higher in populations from low socioeconomic backgrounds ( 5 , 7 , 12 ). People living in disadvantaged communities face many barriers when seeking health care, including inconsistent housing, lack of transportation, financial difficulties, differing cultural beliefs about health care, and mistrust of the medical professions ( 13 , 14 ). People with high rates of medical mistrust tend to be less engaged in their care and to have poor communication with HCPs, which is another factor HCPs need to address when working with their patients with diabetes ( 15 ).
The cost of medical care for people with diabetes was $327 billion in 2017, a 26% increase since 2012 ( 1 , 16 ). Many of these medical expenditures are related to hospitalization and inpatient care, which accounts for 30% of total medical costs for people with diabetes ( 16 ).
People with diabetes also may neglect self-management tasks for various reasons, including low health literacy, lack of diabetes knowledge, and mistrust between patients and HCPs ( 7 , 15 ).
These challenges can be even more pronounced in vulnerable populations because of language barriers and patient-provider mistrust ( 17 – 19 ). Rates of diabetes are higher among racial and ethnic minority groups; 15.1% of American Indians and Alaskan Natives, 12.7% of Non-Hispanic Blacks, 12.1% of Hispanics, and 8% of Asian Americans have diagnosed diabetes, compared with 7.4% of non-Hispanic Whites ( 1 ). Additionally, patient-provider relationship deficits can be attributed to challenges with communication, including HCPs’ lack of attention to speaking slowly and clearly and checking for patients’ understanding when providing education or gathering information from people who speak English as a second language ( 15 ). White et al. ( 15 ) demonstrated that patients with higher provider mistrust felt that their provider’s communication style was less interpersonal and did not feel welcome as part of the decision-making process.
To the authors’ knowledge, there is no current literature review evaluating interventions focused on health literacy and diabetes management. There is a pressing need for such a comprehensive review to provide a framework for future intervention design. The objective of this literature review was to gather and summarize studies of health literacy–based diabetes management interventions and their effects on overall diabetes management. Medication adherence and glycemic control were considered secondary outcomes.
Search Strategy
A literature review was conducted using the PubMed, Medline, and EMBASE databases. Search criteria included articles published between 2015 and 2020 to identify the most recent studies on this topic. The search included the phrases “diabetes” and “health literacy” to specifically focus on health literacy and diabetes management interventions and was limited to original research conducted in humans and published in English within the defined 5-year period. Search results were exported to Microsoft Excel for evaluation.
Study Selection
Initial screening of the articles’ abstracts was conducted using the selection criteria to determine which articles to include or exclude ( Figure 1 ). The initial search results were reviewed for the following inclusion criteria: original research (clinical trials, cohort studies, and cross-sectional studies) conducted in human subjects with type 2 diabetes in the United States, and published in English between 2015 and 2020. Articles were considered to be relevant if diabetes was included as a medical condition in the study and an intervention was made to assess or improve health literacy. Studies involving type 1 diabetes or gestational diabetes and articles that were viewpoints, population surveys, commentaries, case reports, reviews, or reports of interventions conducted outside of the United States were excluded from further review. The criteria requiring articles to be from the past 5 years and from the United States were used because of the unique and quickly evolving nature of the U.S. health care system. Articles published more than 5 years ago or from other health care systems may have contributed information that was not applicable to or no longer relevant for HCPs in the United States. Articles were screened and reviewed independently by both authors. Disagreements were resolved through discussion to create the final list of articles for inclusion.
![sample dissertation topics on type 2 diabetes FIGURE 1. PRISMA diagram of the article selection process.](https://ada.silverchair-cdn.com/ada/content_public/journal/spectrum/34/4/10.2337_ds21-0014/1/m_diaspectds210014f1.jpeg?Expires=1727041720&Signature=CMrabtFQmR0haoXT3GWk0inX6W8dwlTttfW453FfnnR7znWl80IZ0xBQ4g6Y~F~~CtEebC4G7RcEE95HTan~5O5kadE7HWPBr7-FPzXhDKmZjhYFY~u8~vyW7e7JeHyGb77ALt-fGZapNVQQyfUV8izPqrr8sZGPLwkX693QVDfHbs7PzJUSPYKJh0V4nUNn-oZrpaxetLpsiE3dbc3QQ2KQVmwrxzp69HRlCBGD3uETDBN4p-B9oEuSv6XzauLXAoa~Scpl46gMetF90neVbX6zgiddewj3CAAtG~~8-h1Xsle6LkvnMIhiS2M40ROw6HUH2pRDttkG~Dn0kOUH6g__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA)
PRISMA diagram of the article selection process.
Data Extraction
A standard data extraction was performed for each included article to obtain information including author names, year of publication, journal, study design, type of intervention, primary outcome, tools used to assess health literacy or type 2 diabetes knowledge, and effects of intervention on overall diabetes management, glycemic control, and medication adherence.
A total of 1,914 articles were collected from a search of the PubMed, MEDLINE, and EMBASE databases, of which 1,858 were excluded based on the inclusion and exclusion criteria. Of the 56 articles that met criteria for abstract review, 46 were excluded because of a lack of relevance to both diabetes management and health literacy. The remaining 10 studies identified various diabetes management interventions, including diabetes education tools such as electronic medication instructions and text message–based interventions, technology-based education videos, enhanced prescription labels, learner-based education materials, and culturally tailored interventions ( 15 , 20 – 28 ). Figure 1 shows the PRISMA diagram of the article selection process, and Table 1 summarizes the findings of the article reviews ( 15 , 20 – 28 ).
Findings of the Article Reviews (15,20–28)
Article . | Study Design; Sample . | Intervention . | Assessment Tools . | Primary Outcome . | Other Outcomes . | Effects on Glycemic Control . | Effects on Medication Adherence . |
---|---|---|---|---|---|---|---|
Graumlich et al. (20) | RCT; 674 people with type 2 diabetes | Comparison of the use of a medication planning tool (Medtable) vs. standard care to improve diabetes management | REALM and DKT | Medication knowledge | Satisfaction with medication information, medication adherence, A1C | No difference noted between intervention and control groups at 6 months | No difference noted between the intervention and control groups |
Goessl et al. (21) | RCT; 442 people with type 2 diabetes | Comparison of lifestyle-based diabetes prevention education provided in either a recorded DVD format or in in-person sessions designed for people with low health literacy to assess comprehension; curriculum covered physical activity, food choices, and portion sizes, followed by provision of a personalized plan for weight loss | NVS | Information comprehension | None | Not assessed | Not assessed |
Hofer et al. (22) | RCT; 176 Hispanics and African Americans with type 2 diabetes | Participants received a CHW-led medication self-management intervention consisting of a home visit and two follow-up phone calls | SILS | Type 2 diabetes self-efficacy, type 2 diabetes distress, and health literacy | None | Not assessed | Increase in satisfaction with medication information was correlated with improved medication adherence for women |
Kim et al. (23) | RCT; 250 Korean Americans with type 2 diabetes | Culturally tailored type 2 diabetes intervention that included a series of behavioral education sessions, training for self-monitoring of glucose, and individualized counseling sessions using motivational interviewing | DKT | A1C, total cholesterol, and LDL cholesterol | Diabetes Quality of Life measure | Change in A1C was significantly higher in intervention group | Not assessed |
Koonce et al. (24) | RCT; 160 English- or Spanish-speaking people with type 2 diabetes | Education materials based on learning style and health literacy level; material used for the intervention group were developed to reflect content of the DKT | DKT, three-item assessment for health literacy | Change in DKT score | None | Not assessed | Not assessed |
Nelson et al. (25) | RCT; 256 people with type 2 diabetes | A 12-month program of text messages using an electronic interface called MEMOTEXT to support diabetes self-care interventions; messages were tailored based on participants’ medication adherence and the Information-Motivation-Behavioral Skills model of health behavior change, and self-care behaviors such as diet, exercise, and glucose monitoring | Brief Health Literacy Screen | Patient engagement | None | Not assessed | Not assessed |
Sharp et al. (26) | Cross-over trial; 244 African Americans and Hispanics with type 2 diabetes | Assessment of the effect of having access to a clinical pharmacist and CHW on glycemic control; all participants received care from a clinical pharmacist for 2 years and were randomized to receive CHW support either for the first year or the second year | Three-item assessment for health literacy, Spoken Knowledge in Low Literacy in Diabetes Scale | A1C | Changes in systolic and diastolic blood pressure, HDL cholesterol, LDL cholesterol, BMI, quality of life, and perceived social support | Patients enrolled into the sequence with both a CHW and pharmacist had a significant decrease in A1C vs. patients enrolled in the pharmacist-only sequence in year 1 | No change noted in medication adherence in either group |
White et al. (15) | RCT; 410 English- or Spanish-speaking people with type 2 diabetes | Providers in half of 10 clinics were trained on effective health communication and how to communicate with patients with low health literacy; those from the intervention sites were also given the PRIDE toolkit | s-TOFHLA | Association between communication quality and medical mistrust | None | Glycemic control was not correlated with mistrust scores | Not assessed |
Wolff et al. (27) | RCT; 845 English- or Spanish-speaking people with type 2 diabetes who were taking ≥2 oral medications | Participants received PCL for their oral diabetes medication in an effort to improve proper medication use and adherence | REALM, SAHLSA | Proper medication use | Medication adherence | Not assessed | Patients with limited health literacy and those taking medications ≥2 times daily showed significant improvement in medication adherence |
Yeung et al. (28) | Matched, quasi-experiment; 68 people with type 2 diabetes, hypertension, and congestive heart failure | Use of online flashcards and educational videos to improve medication adherence and disease state understanding | REALM, SAHLSA, NVS | Medication adherence | 90-day proportion of days covered | Not assessed | Participants in the intervention group had significantly higher 180-day medication adherence than their matched control subjects |
Article . | Study Design; Sample . | Intervention . | Assessment Tools . | Primary Outcome . | Other Outcomes . | Effects on Glycemic Control . | Effects on Medication Adherence . |
---|---|---|---|---|---|---|---|
Graumlich et al. (20) | RCT; 674 people with type 2 diabetes | Comparison of the use of a medication planning tool (Medtable) vs. standard care to improve diabetes management | REALM and DKT | Medication knowledge | Satisfaction with medication information, medication adherence, A1C | No difference noted between intervention and control groups at 6 months | No difference noted between the intervention and control groups |
Goessl et al. (21) | RCT; 442 people with type 2 diabetes | Comparison of lifestyle-based diabetes prevention education provided in either a recorded DVD format or in in-person sessions designed for people with low health literacy to assess comprehension; curriculum covered physical activity, food choices, and portion sizes, followed by provision of a personalized plan for weight loss | NVS | Information comprehension | None | Not assessed | Not assessed |
Hofer et al. (22) | RCT; 176 Hispanics and African Americans with type 2 diabetes | Participants received a CHW-led medication self-management intervention consisting of a home visit and two follow-up phone calls | SILS | Type 2 diabetes self-efficacy, type 2 diabetes distress, and health literacy | None | Not assessed | Increase in satisfaction with medication information was correlated with improved medication adherence for women |
Kim et al. (23) | RCT; 250 Korean Americans with type 2 diabetes | Culturally tailored type 2 diabetes intervention that included a series of behavioral education sessions, training for self-monitoring of glucose, and individualized counseling sessions using motivational interviewing | DKT | A1C, total cholesterol, and LDL cholesterol | Diabetes Quality of Life measure | Change in A1C was significantly higher in intervention group | Not assessed |
Koonce et al. (24) | RCT; 160 English- or Spanish-speaking people with type 2 diabetes | Education materials based on learning style and health literacy level; material used for the intervention group were developed to reflect content of the DKT | DKT, three-item assessment for health literacy | Change in DKT score | None | Not assessed | Not assessed |
Nelson et al. (25) | RCT; 256 people with type 2 diabetes | A 12-month program of text messages using an electronic interface called MEMOTEXT to support diabetes self-care interventions; messages were tailored based on participants’ medication adherence and the Information-Motivation-Behavioral Skills model of health behavior change, and self-care behaviors such as diet, exercise, and glucose monitoring | Brief Health Literacy Screen | Patient engagement | None | Not assessed | Not assessed |
Sharp et al. (26) | Cross-over trial; 244 African Americans and Hispanics with type 2 diabetes | Assessment of the effect of having access to a clinical pharmacist and CHW on glycemic control; all participants received care from a clinical pharmacist for 2 years and were randomized to receive CHW support either for the first year or the second year | Three-item assessment for health literacy, Spoken Knowledge in Low Literacy in Diabetes Scale | A1C | Changes in systolic and diastolic blood pressure, HDL cholesterol, LDL cholesterol, BMI, quality of life, and perceived social support | Patients enrolled into the sequence with both a CHW and pharmacist had a significant decrease in A1C vs. patients enrolled in the pharmacist-only sequence in year 1 | No change noted in medication adherence in either group |
White et al. (15) | RCT; 410 English- or Spanish-speaking people with type 2 diabetes | Providers in half of 10 clinics were trained on effective health communication and how to communicate with patients with low health literacy; those from the intervention sites were also given the PRIDE toolkit | s-TOFHLA | Association between communication quality and medical mistrust | None | Glycemic control was not correlated with mistrust scores | Not assessed |
Wolff et al. (27) | RCT; 845 English- or Spanish-speaking people with type 2 diabetes who were taking ≥2 oral medications | Participants received PCL for their oral diabetes medication in an effort to improve proper medication use and adherence | REALM, SAHLSA | Proper medication use | Medication adherence | Not assessed | Patients with limited health literacy and those taking medications ≥2 times daily showed significant improvement in medication adherence |
Yeung et al. (28) | Matched, quasi-experiment; 68 people with type 2 diabetes, hypertension, and congestive heart failure | Use of online flashcards and educational videos to improve medication adherence and disease state understanding | REALM, SAHLSA, NVS | Medication adherence | 90-day proportion of days covered | Not assessed | Participants in the intervention group had significantly higher 180-day medication adherence than their matched control subjects |
SAHLSA, Short Assessment of Health Literacy for Spanish Adults.
Medical mistrust and poor communication are challenging variables in diabetes education. White et al. ( 15 ) examined the association between communication quality and medical mistrust in patients with type 2 diabetes. HCPs at five health department clinics received training in effective health communication and use of the PRIDE (Partnership to Improve Diabetes Education) toolkit in both English and Spanish, whereas control sites were only exposed to National Diabetes Education Program materials without training in effective communication. The study evaluated participant communication using several tools, including the Communication Assessment Tool (CAT), Interpersonal Processes of Care (IPC-18), and the Short Test of Functional Health Literacy in Adults (s-TOFHLA). The authors found that higher levels of mistrust were associated with lower CAT and IPC-18 scores.
Patients with type 2 diabetes are also likely to benefit from personalized education delivery tools such as patient-centered labeling (PCL) of prescription drugs, learning style–based education materials, and tailored text messages ( 24 , 25 , 27 ). Wolf et al. ( 27 ) investigated the use of PCL in patients with type 2 diabetes and found that patients with low health literacy who take medication two or more times per day have higher rates of proper medication use when using PCL (85.9 vs. 77.4%, P = 0.03). The objective of the PCL intervention was to make medication instructions and other information on the labels easier to read to improve medication use and adherence rates. The labels incorporated best-practice strategies introduced by the Institute of Medicine for the Universal Medication Schedule. These strategies prioritize medication information, use of larger font sizes, and increased white space. Of note, the benefits of PCL were largely seen with English speakers. Spanish speakers did not have substantial improvement in medication use or adherence, which could be attributed to language barriers ( 27 ).
Nelson et al. ( 25 ) analyzed patients’ engagement with an automated text message approach to supporting diabetes self-care activities in a 12-month randomized controlled trial (RCT) called REACH (Rapid Education/Encouragement and Communications for Health) ( 25 ). Messages were tailored based on patients’ medication adherence, the Information-Motivation-Behavioral Skills model of health behavior change, and self-care behaviors such as diet, exercise, and self-monitoring of blood glucose. Patients in this trial were native English speakers, so further research to evaluate the impact of the text message intervention in patients with limited English language skills is still needed. However, participants in the intervention group reported higher engagement with the text messages over the 12-month period ( 25 ).
Patients who receive educational materials based on their learning style also show significant improvement in their diabetes knowledge and health literacy. Koonce et al. ( 24 ) developed and evaluated educational materials based on patients’ learning style to improve health literacy in both English and Spanish languages. The materials were made available in multiple formats to target four different learning styles, including materials for visual learners, read/write learners, auditory learners, and kinesthetic learners. Spanish-language versions were also available. Researchers were primarily interested in measuring patients’ health literacy and knowledge of diabetes. The intervention group received materials in their preferred learning style and language, whereas the control group received standard of care education materials. The intervention group showed significant improvement in diabetes knowledge and health literacy, as indicated by Diabetes Knowledge Test (DKT) scores. More participants in the intervention group reported looking up information about their condition during week 2 of the intervention and showed an overall improvement in understanding symptoms of nerve damage and types of food used to treat hypoglycemic events. However, the study had limited enrollment of Spanish speakers, making the applicability of the results to Spanish-speaking patients highly variable.
Additionally, findings by Hofer et al. ( 22 ) suggest that patients with high A1C levels may benefit from interventions led by community health workers (CHWs) to bridge gaps in health literacy and equip patients with the tools to make health decisions. In this study, Hispanic and African American patients with low health literacy and diabetes not controlled by oral therapy benefited from education sessions led by CHWs. The CHWs led culturally tailored support groups to compare the effects of educational materials provided in an electronic format (via iDecide) and printed format on medication adherence and self-efficacy. The study found increased adherence with both formats, and women, specifically, had a significant increase in medication adherence and self-efficacy. One of the important aspects of this study was that the CHWs shared cultural and linguistic characteristics with the patients and HCPs, leading to increased trust and satisfaction with the information presented ( 22 ).
Kim et al. ( 23 ) found that Korean-American participants benefited greatly from group education sessions that provided integrated counseling led by a team of nurses and CHW educators. The intervention also had a health literacy component that focused on enhancing skills such as reading food package labels, understanding medical terminology, and accessing health care services. This intervention led to a significant reduction of 1–1.3% in A1C levels in the intervention group. The intervention established the value of collaboration between CHW educators and nurses to improve health information delivery and disease management.
A collaboration between CHW educators and pharmacists was also shown to reinforce diabetes knowledge and improve health literacy. Sharp et al. ( 26 ) conducted a cross-over study in four primary care ambulatory clinics that provided care for low-income patients. The study found that patients with low health literacy had more visits with pharmacists and CHWs than those with high health literacy. The CHWs provided individualized support to reinforce diabetes self-management education and referrals to resources such as food, shelter, and translation services. The translation services in this study were especially important for building trust with non-English speakers and helping patients understand their therapy. Similar to other studies, the CHWs shared cultural and linguistic characteristics with their populations, which helped to overcome communication-related and cultural barriers ( 23 , 26 ).
The use of electronic tools or educational videos yielded inconclusive results with regard to medication adherence. Graumlich et al. ( 20 ) implemented a new medication planning tool called Medtable within an electronic medical record system in several outpatient clinics serving patients with type 2 diabetes. The tool was designed to organize medication review and patient education. Providers can use this tool to search for medication instructions and actionable language that are appropriate for each patient’s health literacy level. The authors found no changes in medication knowledge or adherence, but the intervention group reported higher satisfaction. On the other hand, Yeung et al. ( 28 ) showed that pharmacist-led online education videos accessed using QR codes affixed to the patients’ medication bottles and health literacy flashcards increased patients’ medication adherence in an academic medical hospital.
Goessl et al. ( 21 ) found that patients with low health literacy had significantly higher retention of information when receiving evidence-based diabetes education through a DVD recording than through an in-person group class. This 18-month RCT randomized participants to either the DVD or in-person group education and assessed their information retention through a teach-back strategy. The curriculum consisted of diabetes prevention topics such as physical exercise, food portions, and food choices. Participants in the DVD group had significantly higher retention of information than those in the control (in-person) group. The authors suggested this may have been because participants in the DVD group have multiple opportunities to review the education material.
Management of type 2 diabetes remains a challenge for HCPs and patients, in part because of the challenges discussed in this review, including communication barriers between patients and HCPs and knowledge deficits about medications and disease states ( 29 ). HCPs can have a positive impact on the health outcomes of their patients with diabetes by improving patients’ disease state and medication knowledge.
One of the common themes identified in this literature review was the prevalence of culturally tailored diabetes education interventions. This is an important strategy that could improve diabetes outcomes and provide an alternative approach to diabetes self-management education when working with patients from culturally diverse backgrounds. HCPs might benefit from using culturally tailored educational approaches to improve communication with patients and overcome the medical mistrust many patients feel. Although such mistrust was not directly correlated with diabetes management, it was noted that patients who feel mistrustful tend to have poor communication with HCPs ( 20 ). Additionally, Latino/Hispanic patients who have language barriers tend to have poor glycemic control ( 19 ). Having CHWs work with HCPs might mitigate some patient-provider communication barriers. As noted earlier, CHWs who share cultural and linguistic characteristics with their patient populations have ongoing interactions and more frequent one-on-one encounters ( 12 ).
Medication adherence and glycemic control are important components of diabetes self-management, and we noted that the integration of CHWs into the diabetes health care team and the use of simplified medication label interventions were both successful in improving medication adherence ( 23 , 24 ). The use of culturally tailored education sessions and the integration of pharmacists and CHWs into the management of diabetes appear to be successful in reducing A1C levels ( 12 , 26 ). Electronic education tools and educational videos alone did not have an impact on medication knowledge or information retention in patients with low health literacy, but a combination of education tools and individualized sessions has the potential to improve diabetes medication knowledge and overall self-management ( 20 , 22 , 30 ).
There were several limitations to our literature review. We restricted our search criteria to articles published in English and studies conducted within the United States to ensure that the results would be relevant to U.S. HCPs. However, these limitations may have excluded important work on this topic. Additional research expanding this search beyond the United States and including articles published in other languages may demonstrate different outcomes. Additionally, this literature review did not focus on A1C as the primary outcome, although A1C is an important indicator of diabetes self-management. A1C was chosen as the method of evaluating the impact of health literacy interventions in patients with diabetes, but other considerations such as medication adherence, impact on comorbid conditions, and quality of life are also important factors.
The results of this work show that implementing health literacy interventions to help patients manage type 2 diabetes can have beneficial results. However, such interventions can have significant time and monetary costs. The potential financial and time costs of diabetes education interventions were not evaluated in this review and should be taken into account when designing interventions. The American Diabetes Association estimated the cost of medical care for people with diabetes to be $327 billion in 2017, with the majority of the expenditure related to hospitalizations and nursing home facilities ( 16 ). Another substantial cost of diabetes that can be difficult to measure is treatment for comorbid conditions and complications such as cardiovascular and renal diseases.
Interventions designed to address low health literacy and provide education about type 2 diabetes could be a valuable asset in preventing complications and reducing medical expenditures. Results of this work show that clinicians who are considering implementing new interventions may benefit from the following strategies: using culturally tailored approaches, creating materials for different learning styles and in patients’ languages, engaging CHWs and pharmacists to help with patient education, using PCLs for medications, and engaging education session instructors who share patients’ cultural and linguistic characteristics.
Diabetes self-management is crucial to improving health outcomes and reducing medical costs. This literature review identified interventions that had a positive impact on provider-patient communication, medication adherence, and glycemic control by promoting diabetes self-management through educational efforts to address low health literacy. Clinicians seeking to implement diabetes care and education interventions for patients with low health literacy may want to consider drawing on the strategies described in this article. Providing culturally sensitive education that is tailored to patients’ individual learning styles, spoken language, and individual needs can improve patient outcomes and build patients’ trust.
Duality of Interest
No potential conflicts of interest relevant to this article were reported.
Author Contributions
Both authors conceptualized the literature review, developed the methodology, analyzed the data, and wrote, reviewed, and edited the manuscript. R.A. collected the data. K.M. supervised the review. K.M. is the guarantor of this work and, as such, has full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Prior Presentation
Portions of this research were presented at the Washington State University College of Pharmacy and Pharmaceutical Sciences Honors Research Day in April 2019.
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