Is It Time to Screen Health Literacy in Diabetes Clinical Practice?

Globally ≈10% of adults have diabetes [ [1] IDF. 9th Atlas IDF. International Diabetes Federation: Diabetes Atlas. Brussels, Belgium; 2019. Google Scholar ], with associated risk of acute and chronic complications and comorbidities. Even in advantaged regions most people with diabetes have multiple risk factors and <20% of people with Type 1 diabetes (T1D) or Type 2 diabetes (T2D) meet the recommended HbA1c target of <7% (53 mmol/mol) [ 2 Lan N.S.R. et al. Patient perceptions of cardiovascular risk, lipid management and statins in type 1 diabetes. Prim Care Diabetes. 2023; 17: 526-528 Google Scholar , 3 Pease A. et al. Burden of cardiovascular risk factors and disease among patients with type 1 diabetes: results of the Australian National Diabetes Audit (ANDA). Cardiovasc Diabetol. 2018; 17: 77 Google Scholar ]. People with diabetes usually spend several hours a year (<0.02% time) with their healthcare professionals, hence patient education, support, empowerment and self-management are key [ [4] Marrero D.G. Diabetes Care and Research: What Should Be the Next Frontier?. Diabetes Spectr. 2016; 29: 54-57 Google Scholar ]. People with diabetes may receive information from multiple formal and informal sources, including healthcare professionals and organisations, lay people, organisations and social media. People with diabetes consider many factors, including lifestyle, medications, technology, risk factors, mental health, including diabetes stigma, other health conditions and multiple appointments. Challenges, inattention or inertia and suboptimal mental and physical well-being may arise when information is contrasting, complex or excessive or when the person’s knowledge, skills, support, time and finances are suboptimal. Also, hypoglycaemia, hyperglycaemia, ketosis or dehydration may acutely impair cognition and trigger cardiovascular events [ 5 Brands A.M. et al. The effects of type 1 diabetes on cognitive performance: a meta-analysis. Diabetes Care. 2005; 28: 726-735 Google Scholar , 6 Iqbal A. Storey R.F. Ajjan R.A. Prolonged Inflammatory Response Post-Hypoglycemia: Mechanistic Insights Into the Relationship Between Low Glucose and Cardiovascular Risk. Diabetes. 2022; 71: 2483-2485 Google Scholar , 7 Masento N.A. et al. Effects of hydration status on cognitive performance and mood. Br J Nutr. 2014; 111: 1841-1852 Google Scholar ]. Health literacy, discussed below, is a broad concept and key determinant of health for all people.