Good Literacy to Enhance Response in Diabetes Mellitus (GLITTER-DM)

  • Yen Dang University of Maryland Eastern Shore
  • Nima Patel-Shori Temple University, School of Pharmacy, Department of Pharmacy Practice
  • Michael Barros Temple University, School of Pharmacy, Department of Pharmacy Practice
  • Daohai Yu Temple University, School of Medicine, Department of Clinical Sciences
Keywords: health literacy, diabetes, education, teach-back, action plans


Objective: The purpose of this study is to determine the effectiveness of individualized communication strategies and self-management action plans to improve A1c control at 3 months in patients with low health literacy.

Methods: A prospective, open-labeled, pilot study was conducted on 23 patients with diabetes mellitus in a pharmacist-led ambulatory care clinic. Patients who had a Rapid Estimate of Adult Literacy in Medicine- Revised (REALM-R) score of 6 or less and an A1c greater than 7% upon study entry were included. The first group received the teach-back method, personalized actions, and follow-up phone calls to assess comprehension (N = 12). The second group was assigned to usual care (N = 11).

Results: Patients receiving literacy-appropriate interventions had greater A1c percent reduction (A1c difference of -2.0 ± 1.3 vs -1.0 ± 2.2; P = 0.02) and less hyperglycemic events per week (0.1 vs. 2.1; P = 0.04). There were no differences in the number of hypoglycemic events, testing frequency, medication-adherence rates, or hospitalizations and emergency room visits related to diabetes.

Conclusion: Literacy-appropriate methods such as the teach-back method, personalized action plans, and telephone follow-ups may improve glycemic control in low health literate patients with diabetes.

Practice Implications and Innovations: The findings from this study suggest that pharmacists may improve diabetes outcomes when managing patients who possess low health literacy using simplified teaching methods.


Original Research


Download data is not yet available.
Received 2019-12-01
Accepted 2020-02-10
Published 2020-07-31
Practice-Based Research