Illiteracy and diabetes. Strategies for addressing them

Abstract

Illiteracy marginalizes individuals, limiting their inclusion in the workforce and society. For those with diabetes, however, it also presents a severe—yet frequently overlooked—therapeutic obstacle; because it is a source of shame, this limitation is rarely disclosed voluntarily.

Lacking basic literacy and numeracy skills, these patients are unable to self-monitor and record their results, understand and properly follow instructions, self-administer insulin, or interpret educational materials. They also struggle to attend medical appointments on time—or at all—without an accompanying person, leading to missed appointments or attendance on the wrong days or at the wrong times.

In most cases, their condition limits their employment opportunities and, consequently, their ability to adopt recommended lifestyle changes.

This situation undermines treatment adherence and increases vulnerability to complications. In response to this reality, we developed strategies to identify illiteracy in the clinical setting and devised a specialized therapeutic approach for this patient group regarding insulin therapy, medication use, and lifestyle; we present the experience and results from the 25 years since the inception of the adult literacy plan for patients with diabetes—run by the Diabetology Unit at Santamarina Hospital in Monte Grande, Buenos Aires—which offers official primary education certification, a health-focused curriculum, and training in diabetes self-care. Several intervention studies were conducted with participants of this plan—notably involving small sample sizes—which demonstrated (1), (2) improvements in skills and metabolic control. Conclusion: Illiteracy is a therapeutic hurdle that is not always recognized or investigated. Screening and educational interventions designed to tailor treatment to this specific profile proved beneficial for the studied population.