Diabetes numeracy: An overlooked factor in understanding racial disparities in glycemic control

Chandra Y. Osborn, Kerri Cavanaugh, Kenneth A. Wallston, Richard O. White, Russell L. Rothman

Research output: Contribution to journalArticlepeer-review

78 Scopus citations

Abstract

OBJECTIVE - Understanding the reasons and eliminating the pervasive health disparities in diabetes is a major research, clinical, and health policy goal. We examined whether health literacy, general numeracy, and diabetes-related numeracy explain the association between African American race and poor glycemic control (A1C) in patients with diabetes. RESEARCH DESIGN AND METHODS - Adults with type 2 diabetes (n = 383) were enrolled in a cross-sectional study at primary care and diabetes clinics at three medical centers. Data collected included the following: self-reported race, health literacy, general numeracy, diabetes-related numeracy, A1C, and sociodemographic factors. A series of structural equation models were estimated to explore the interrelations between variables and test for mediation. RESULTS - In model 1, younger age (r = -0.21, P < 0.001), insulin use (r = 0.27, P < 0.001), greater years with diabetes (r = 0.16, P < 0.01), and African American race (r = 0.12, P < 0.01) were all associated with poorer glycemic control. In model 2, diabetes-related numeracy emerged as a strong predictor of A1C (r=-0.46, P < 0.001), reducing the association between African American and poor glycemic control to nonsignificance (r = 0.10, NS). In model 3, African American race and older age were associated with lower diabetes-related numeracy; younger age, insulin use, more years with diabetes, and lower diabetes-related numeracy were associated with poor glycemic control. CONCLUSIONS - Diabetes-related numeracy reduced the explanatory power of African American race, such that low diabetes-related numeracy, not African American race, was significantly related to poor glycemic control. Interventions that address numeracy could help to reduce racial disparities in diabetes.

Original languageEnglish (US)
Pages (from-to)1614-1619
Number of pages6
JournalDiabetes care
Volume32
Issue number9
DOIs
StatePublished - Sep 2009

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

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