Department of Primary Care at Hamburg University Medical Center, Hamburg, Germany.
Hamburg Authority of Health and Consumer Protection, Hamburg, Germany.
BMC Public Health. 2021 Mar 16;21(1):510. doi: 10.1186/s12889-021-10508-2.
Low health literacy is believed to be associated with behaviours that increase the risk of type 2 diabetes. But there is limited knowledge on the relation between health literacy (HL) and diabetes risk, and whether improving HL could be a potential prevention strategy. Therefore, the main purpose of this study was to examine the link between HL and diabetes risk among non-diabetic adults.
We used data from the Hamburg Diabetes Prevention Survey, a population-based cross-sectional study in Germany. One thousand, two hundred and fifty-five non-diabetic subjects aged 18-60 years were eligible. The German Diabetes Risk Score (GDRS, ranging 0 to 123 points) was used to determine the individual risk of type 2 diabetes. The short version of the European Health Literacy Questionnaire (HLS-EU-Q16, ranging 0 to 16 points) was applied to assess the individual self-reported HL. Subjects were asked to self-estimate their diabetes risk, which was then compared with the calculated GDRS. Descriptive statistics were calculated to investigate group differences in the GDRS and self-estimated diabetes risk. Linear as well as logistic regression models were performed to analyse potential influencing variables of the GDRS as well as incorrect self-estimated diabetes risk. In three nested statistical models for each outcome, these analyses were adjusted for age, gender, educational level and the presence of chronic conditions.
According to the criteria of the GDRS, 996 (79.4%) subjects showed "low risk", 176 (14.0%) "still low risk", 53 (4.2%) "elevated risk", and 30 (2.4%) "high to very high risk" to develop type 2 diabetes within the next 5 years. In the statistical models including all control variables, subjects with "inadequate HL" scored 2.38 points higher on the GDRS (95% CI 0.378 to 4.336; P = 0.020) and had a 2.04 greater chance to estimate their diabetes risk incorrectly (OR 2.04; 95% CI 1.33 to 3.14; P = 0.001) compared to those with "sufficient HL".
The risk of type 2 diabetes is increased in people with inadequate self-reported HL. People with high diabetes risk and inadequate HL might be provided with educational programs to improve diabetes knowledge and reduce behavioural risk factors.
低健康素养被认为与增加 2 型糖尿病风险的行为有关。但是，关于健康素养（HL）与糖尿病风险之间的关系以及提高 HL 是否可能成为潜在的预防策略，我们的了解有限。因此，本研究的主要目的是检验非糖尿病成年人 HL 与糖尿病风险之间的联系。
我们使用了德国汉堡糖尿病预防调查的数据，这是一项基于人群的横断面研究。共有 1255 名 18-60 岁的非糖尿病受试者符合条件。使用德国糖尿病风险评分（GDRS，范围为 0 至 123 分）来确定 2 型糖尿病的个体风险。应用欧洲健康素养问卷（HLS-EU-Q16，范围 0 至 16 分）的简短版本来评估个体自我报告的 HL。要求受试者自我估计他们的糖尿病风险，然后将其与计算得出的 GDRS 进行比较。进行描述性统计分析，以调查 GDRS 和自我估计的糖尿病风险方面的组间差异。进行线性和逻辑回归模型分析，以分析 GDRS 的潜在影响因素以及不正确的自我估计的糖尿病风险。对于每种结果，在三个嵌套的统计模型中，这些分析均根据年龄，性别，教育程度和慢性病的存在进行了调整。
根据 GDRS 的标准，996（79.4％）名受试者表现出“低风险”，176（14.0％）名受试者表现出“仍处于低风险”，53（4.2％）名受试者表现出“风险升高”，30（2.4％）名受试者表现出“高至极高风险”，在未来 5 年内患有 2 型糖尿病的风险。在包括所有对照变量的统计模型中，HL“不足”的受试者的 GDRS 评分高 2.38 分（95％CI 0.378 至 4.336；P=0.020），并且更有可能错误估计其糖尿病风险（OR 2.04；95％CI 1.33 至 3.14；P=0.001），而 HL“充足”的受试者则更高。
自我报告 HL 不足的人患 2 型糖尿病的风险增加。高糖尿病风险和 HL 不足的人可能会接受教育计划，以提高糖尿病知识并减少行为危险因素。
