Association between health literacy and glycemic control in elderly patients with type 2 diabetes and modifying effect of social support

Souza, Jonas Gordilho; Farfel, José Marcelo; Jaluul, Omar; Queiroz, Márcia Silva; Nery, Márcia

doi:10.31744/einstein_journal/2020AO5572

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Einstein (São Paulo) 18 • 2020 • https://doi.org/10.31744/einstein_journal/2020AO5572 copy

Association between health literacy and glycemic control in elderly patients with type 2 diabetes and modifying effect of social support

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To investigate the association between inadequate functional health literacy, considering the Short Assessment of Health Literacy for Portuguese-speaking Adults, and glycemic control in elderly patients with type 2 diabetes, and to examine this association in low social support settings, according to Medical Outcomes Study .

Methods:

Cross-sectional study conducted at the diabetes referral center of a university hospital. Participants were recruited among type 2 diabetes patients aged 60 years or older, between May 2013 and November 2014. The primary outcome was the most recent glycated hemoglobin value measured within the last 6 months.

Results:

A total of 398 elderly patients with type 2 diabetes were evaluated. Of these, 232 were not eligible to participate. The final sample comprised 166 participants. Hierarchical multiple linear regression was performed. The following variables were entered in three blocks: sociodemographic characteristics, clinical variables and health literacy scores. Regression analysis of the interaction between health literacy and social support as a determinant of glycemic control was also performed. Mean age of subjects was 68.0 years (standard deviation of 5.9). Mean glycated hemoglobin value was 8.5% (standard deviation of 1.4). Short assessment of health literacy for Portuguese speaking adults score was independently associated with glycated hemoglobin (B=-0.059; p=0.043). The interaction between social support and health literacy score (p=0.003) was a determinant of glycemic control.

Conclusion:

Health literacy is associated with glycemic control. Social support may modify the relation between health literacy and glycemic control.

Keywords:
Health literacy; Diabetes mellitus , type 2; Blood glucose; Aged; Health of the elderly

Instrument	Portuguese version	Range	Interpretation
SAHLPA short version – evaluates health literacy	Apolinario et al.⁽⁴4. Apolinario D, Braga R de C, Magaldi RM, Busse AL, Campora F, Brucki S, et al. Short assessment of health literacy for Portuguese-speaking adults. Rev Saúde Pública. 2012; 46(4):702-11.⁾	0-18	Analyzed as an interval variable. Can be analyzed as a dichotomous variable; scores <14 define poor health literacy
SKILLD – evaluates diabetes knowledge	Souza et al.⁽²⁶26. Souza JG, Apolinario D, Farfel JM, Jaluul O, Magaldi RM, Busse AL, et al. Applicability of the Spoken Knowledge in Low Literacy Patients with Diabetes in Brazilian elderly. einstein (São Paulo). 2016;14(4):513-9.⁾	0-10	Analyzed as an interval variable. No cut-off value
MOS – evaluates 5 social support dimensions	Griep et al.⁽²⁷27. Griep RH, Chor D, Faerstein E, Werneck GL, Lopes CS. Validade de constructo de escala de apoio social do Medical Outcomes Study adaptada para o português no Estudo Pró-Saúde. Cad Saúde Pública. 2005;21(3):703-14.⁾	0-95	Analyzed as an interval variable; data sets divided into terciles. No cut-off value
MRCI – evaluates pharmacological treatment complexity	Melchiors et al.⁽²⁸28. Melchiors AC, Correr CJ, Fernández-Llimos F. Translation and validation into portuguese language of the medication regimen complexity index. Arq Bras Cardiol. 2007;89(4):210-8.⁾	Up to 0	Analyzed as an interval variable. No cut-off value
GDS-15 – evaluates symptoms of depression	Almeida et al.⁽³⁰30. Almeida OP, Almeida SA. Short versions of the geriatric depression scale: a study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV. Int J Geriatr Psychiatry. 1999;14(10):858-65.⁾	0-15	Participants scoring >5 were considered depressed

Characteristics	Total
Age, years	68.0±5.9
Female sex	104.0 (62.7)
White race	63.0 (38.0)
Manual labor	86.0 (51.8)
BCEC	20.6±6.5
Schooling, years	6.5±5.1
Married or in stable relationship	83.0 (50.0)
Social support according to MOS score	81.5±17.9
Disease duration, years	18.5±8.8
Need for help with medication	35.0 (21.1)
Insulin use	120.0 (72.3)
Use of insulin pen	9.0 (5.4)
Diabetes knowledge according to SKILLD	6.6±1.8
Adherence to diabetes medication	110.0 (66.3)
MRCI	45.7±16.1
Symptoms of depression according to GDS 15 >5	43.0 (25.9)
BMI, kg/m² (6 MD)	30.3±5.4
SAHLPA score	13.3±5.0
HbA1c	8.5±1.4

Characteristics		Mean HbA1c (SD)	Pearson's correlation coefficient	p value
Age			-0.148	0.057 ^* * Pearson's correlation test;
Sex				0.939 ^† † Student´s t test to compare means between two groups.
	Female	8.5 (1.5)
	Male	8.5 (1.2)
Race				0.876 ^† † Student´s t test to compare means between two groups.
	White	8.5 (1.8)
	Others	8.5 (1.3)
Labor				0.076 ^† † Student´s t test to compare means between two groups.
	Manual	8.7 (1.5)
	Not manual	8.3 (1.2)
BCEC (1 MD)			-0,.136	0.080 ^* * Pearson's correlation test;
Schooling, years			-0.058	0.455 ^* * Pearson's correlation test;
Marital status				0.733 ^† † Student´s t test to compare means between two groups.
	Married or in stable relationship	8.5 (1.2)
	Others	8.4 (1.6)
Social support according to MOS			-0.063	0.080 ^* * Pearson's correlation test;
Disease duration, years			0.081	0.455 ^* * Pearson's correlation test;
Need for help with medication				0.342 ^† † Student´s t test to compare means between two groups.
	No	8.4 (1.3)
	Yes	8.7 (1.5)
Insulin use
	No	7.8 (0.9)		<0.001 ^† † Student´s t test to compare means between two groups.
	Yes	8.7 (1.5)
Diabetes knowledge according to SKILLD			-0.090	0.248 ^* * Pearson's correlation test;
Adherence to diabetes medication				0.746 ^† † Student´s t test to compare means between two groups.
	No	8.5 (1.4)
	Yes	8.5 (1.4)
MRCI			0.317	<0.001 ^* * Pearson's correlation test;
Symptoms of depression according to GDS 15 >5				0.016 ^† † Student´s t test to compare means between two groups.
	Not depressed	8.3 (1.3)
	Depressed	8.9 (1.4)
BMI, kg/m² (6 MD)			0.192	0.015 ^* * Pearson's correlation test;
SAHLPA			-0.121	0.120 ^* * Pearson's correlation test;

Characteristics	No adjustment ^* * Univariate regression;		Model 1 ^† † hierarchical multiple linear regression using HbA1c value as the dependent variable; R²=0.029		Model 2 ^† † hierarchical multiple linear regression using HbA1c value as the dependent variable; R²=0.122		Model 3 ^† † hierarchical multiple linear regression using HbA1c value as the dependent variable; R²=0.140
Characteristics	Beta	p value	beta	p value	beta	p value	beta	p value
Age, years	-0.034	0.057	-0.043	0.022	-0.040	0.053	-0.500	0.018
Female versus male sex	0.017	0.939	-0.025	0.913	-0.183	0.441	-0.189	0.421
White versus other races	0.035	0.876	0.237	0.303	0.174	0.440	0.294	0.204
Manual versus not manual labor	0.381	0.076	0.492	0.028	0.231	0.335	0.120	0.621
Social support according to MOS score	-0.005	0.418			0.006	0.394	-0.009	0.197
Disease duration, years	0.013	0.302			0.017	0.226	0.018	0.204
Diabetes knowledge according to SKILLD	-0.070	0.248			0.129	0.061	-0.111	0.108
MRCI	0.027	<0.001			0.022	0.002	0.024	0.001
Adherence to diabetes medication	-0.74	0.746			0.009	0.967	0.004	0.986
Symptoms of depression according to GDS 15 >5 depressed versus not depressed	0.585	0.016			0.173	0.546	0.029	0.922
BMI, kg/m²^‡ ‡ 6 missing data.	0.049	0.015			0.030	0.146	0.024	0.241
SAHLPA	-0.034	0.120					-0.052	0,044

Instituto Israelita de Ensino e Pesquisa Albert Einstein Avenida Albert Einstein, 627/701 , 05651-901 São Paulo - SP, Tel.: (55 11) 2151 0904 - São Paulo - SP - Brazil
E-mail: revista@einstein.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author: Jonas Gordilho de Souza, Department of Internal Medicine and Diagnostic Support of Faculdade de Medicina da Bahia of Universidade Federal da Bahia Praça XV de Novembro, Largo do Terreiro de Jesus Zip code: 40026-010 – Salvador, BA, Brazil. Phone: (55 71) 3283-5577 E-mail: jonas.gordilho@gmail.com