Health literacy of patients using continuous glucose monitoring.

Background: Low health literacy and numeracy are associated with poor health outcomes and lower self-efficacy. Continuous glucose monitors (CGMs) can improve diabetes management, but their benefits may be limited by health literacy levels.

Objectives: Our objective was to characterize health literacy levels of ambulatory care patients using CGMs to manage their diabetes in 1 urban health system. Secondary aims were to identify specific knowledge deficits related to CGM education and determine predictors of self-rated comfort with and understanding of CGM use.

Methods: Participants with type 1 or type 2 diabetes using CGMs were identified using electronic medical records. Participants completed a telephone survey, including the Health Literacy Scale/Subjective Numeracy Scale (HLS/SNS) and an investigator-developed survey assessing CGM comfort and understanding. Descriptive statistics were reported for demographic information. The associations between patient characteristics and survey responses were evaluated using the chi-square test, Fisher's exact test, or Wilcoxon rank-sum test.

Results: Eighty-two participants completed the surveys. The median HLS/SNS score for study participants was 80 (Interquartile range 71-89). Associations were found between HLS/SNS scores and education level, reported income, and private insurance coverage. Participants with higher HLS/SNS scores reported higher levels of CGM understanding and comfort. Fifty-one percent of participants (n = 42) reported no or inadequate training prior to CGM initiation. Better A1C results (<8%) were associated with higher self-rated responses in the investigator-developed survey.

Conclusion: CGMs should not be withheld from individuals with low health literacy. Incorporating baseline health literacy assessment and offering literacy sensitive training will help optimize the benefits derived from this technology.