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Shani Reich, Suzanne Walter, Hillel W Cohen, Jonathan Levine; Health literacy and our diabetic patients-does it matter?. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5336. doi: https://doi.org/.
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Hyperglycemia is a major cause of the microvascular complications that occur in diabetes mellitus (DM), including retinopathy. We hypothesize that despite compliance with regular follow-up examinations, the patients in our inner city eye clinic do not understand the potential complications of DM. The objective of our study is to assess our patients’ understanding of DM and to correlate it with their HbA1C levels and with the severity of their retinopathy.
Our cohort, consisting primarily of Hispanic and African-American patients, were given a questionnaire in Spanish or English that assessed their understanding of DM. Specifically, we asked if they feel informed about how DM affects their eyes and general health, and if they understand the clinical relevance of HbA1C levels. We correlated questionnaire responses with severity of retinopathy, need for therapeutic intervention (retinal photocoagulation, intravitreal injection) and HbA1C level.
Of 102 patients surveyed to date, 66% are Hispanic, 27% African-American, and 7% other. The average age is 63 years ±11.5 and 40% are male. Hispanic patients are more likely to be followed in retina subspecialty clinic (p <0.08) and to receive treatment (p < 0.04) independent of severity of retinopathy and HbA1C level. While 71% of patients feel informed about the general sequelae of DM and 70% feel informed about the ocular morbidity of DM, only 32% and 34%, respectively, understand the relevance of HbA1C, with a trend toward significance (p = 0.115 and 0.055). Furthermore, amongst the latter group of patients who understand the relevance of HbA1C, there is a significant correlation between what they state as their last measured HbA1C level with the actual value as charted in their EMR (Spearman’s Rho(ρ) 0.46 p< 0.001). Severity of retinopathy and presence of therapeutic intervention both correlate significantly with HbA1C (ρ 0.46 (p <0.001) and ρ 0.308 (p <0.006)).
This study demonstrates a significant gap in health literacy within our primarily Hispanic patient population. Though most of our patients feel informed about DM, the majority actually do not know what HbA1C level is. Further investigation is warranted to determine if this correlates with poorer diabetic control or eye health. Ophthalmologists can play a vital role as DM educators, to reinforce patients’ understanding of how DM affects their eyes as well as their general health.
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