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Limited health literacy, common in patients with diabetes, has been associated with worse diabetes outcomes (1–4). While patients with limited health literacy have worse diabetes knowledge (2–5), knowledge does not necessarily predict outcomes (6–8). Because diabetes requires extensive self-care, differences in self-management behaviors may be a key contributor to the disparity in outcomes. In fact, low health literacy has been associated with poor self-care in other chronic illnesses (9,10). However, no study has examined the relationship between health literacy and self-management behaviors in patients with diabetes. In addition, studies have not assessed whether diabetes education, which is widely recommended, is effective in improving self-management behaviors in patients with limited health literacy. The objectives of our study were to examine the association of health literacy with self-management behaviors in patients with diabetes and to determine whether diabetes education improves self-management behaviors in patients with limited compared with adequate health literacy. Understanding the relationship between health literacy and self-management behaviors should enhance efforts to improve diabetes outcomes.We conducted a prospective observational study of patients enrolled in diabetes education classes at the Hospital of the University of Pennsylvania. The classes consist of an individual meeting with a diabetes educator and three weekly 3-h group classes and are recognized by the American Diabetes Association (11). All patients ≥18 years of age present for a regularly scheduled diabetes class were recruited. …

Association of Health Literacy With Self-Management Behavior in Patients With Diabetes