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The aim of this study was to examine the association between educational attainment and utilization of the health care system and self-care behavior by individuals with diabetes. The Barriers to Diabetes Care Survey asked indi- viduals with diabetes about their care. The questionnaire was completed using computer-assisted telephone interviewing techniques. Participants were found by random digit dialing across Ontario, Canada (eligible n = 1,031). We dichotomized educational attainment at high school. We examined the relationship of educational attainment with measures of health care system utilization and of self-care behavior. We adjusted for age, sex, income, health insurance status, and diabetes type, duration and treatment regimen. Individuals with high educational attainment were more likely to have had an oph- thalmologic examination during the previous year (odds ratio 1.37, 95% confidence interval 1.04-1.82), and were more likely to report having a specialist (OR 2.08, 95% CI 1.31-3.31) or other paramedical professional (OR 1.91, 95% CI 1.19-3.07) as their most responsible provider of care, rather than a family doctor. Smoking (OR 0.64, 95% CI 0.45-0.90) and blood sugar monitoring (OR 0.70, 95% CI 0.50-0.98) were associated with low educational attainment, while follow- ing a meal plan was associated with high educational attainment (OR 1.39, 95% CI 1.07-1.80). Since appropriate utiliza- tion of the health care system and self-care behavior are essential for diabetes management, our findings suggest that peo- ple with low educational attainment are independently at risk for worse diabetes care. Health care providers should ensure that their communications, teaching materials and instructions are suitable for these higher-risk patients.

Educational Attainment is Associated with Health Care Utilization and Self-Care Behavior by Individuals with Diabetes