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Blood sugar control related to math, not African-American race

By Craig Boerner
January 2010

Diabetes management can be severely hampered if the patient is not good at math, according to a new Vanderbilt Medical Center study published in the September 2009 issue of Diabetes Care.

The findings from Chandra Y. Osborn, Ph.D., M.P.H., lead author of the paper and an assistant professor of Medicine in the Center for Health Services Research and Prevention and Control Core of the Diabetes Research and Training Center (DRTC), may also help explain some racial differences in diabetes control.

African-Americans have been found to have worse blood sugar control and higher rates of complications, such as heart disease and kidney failure, than whites do, and Vanderbilt researchers now report that it is a diabetes-related numeracy issue as much as a racial difference.

“We were looking to see, first and foremost, whether or not there was an association between African-American race and poor glycemic control, which is a finding that has been consistently shown,” Osborn said.
“Once we did that, we wanted to see whether or not one’s health literacy skills, general numeracy skills, and/or diabetes-related numeracy skills accounted for that relationship. This has never been looked at before. Based on our findings, I would say that knowing how to use and apply numbers to manage your diabetes is more important than your race.”
Vanderbilt researchers administered a diabetes-related numeracy test to 383 adults with type 1 and type 2 diabetes to gauge their ability to interpret nutrition labels, count calories and carbohydrates and keep track of medication doses.

They found that patients with the strongest diabetes-related numeracy scores also had better results on their A1C test, which estimates a patient’s average blood sugar level over the past three months.

“If you have diabetes there are certain skills that you need,” Osborn said. “You need to be able to know ranges of numbers, you need to be able to know that a blood glucose level of 120 is less than 150, you need to know how to count carbohydrates, calculate portion sizes, read food labels.”
“It really requires basic skills, add and calculate … and even, oftentimes, multiplying numbers to be able to know exactly, based on the portion size amount, how many carbohydrate grams are in that serving of food.”
Russell L. Rothman, M.D., M.P.P., and colleagues in the Prevention and Control Core of the DRTC have created a numeracy sensitive diabetes education toolkit that aims to help individuals learn how to control their portion sizes, learn how to count carbohydrates, and learn how to read food labels at a very basic mathematical level.

“We haven’t tested whether or not the toolkit reduces disparities in blood sugar control, but potentially, given what our finding was in Diabetes Care, this would suggest that if we are able to overcome the barrier of poor diabetes-related numeracy then this actually would be able to minimize the disparity that we see between African-Americans and whites in their blood sugar control,” Osborn said.

“If we develop tools geared toward overcoming that barrier, simplifying that information and the numerical demands on patients, or educate them in a way that math doesn’t become a barrier to understanding, then it would make sense that we would be able to reduce that disparity.”

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