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To the Editor: Dr Schillinger and colleagues¹ found a relationship between health literacy and glycosylated hemoglobin (HbA_1c) levels in low-income urban patients in San Francisco. Unlike Schillinger et al, however, we² did not identify a relationship between health literacy and HbA_1c levels among patients in North Carolina with poor diabetic control (HbA_1c 8.0%). The lack of a significant relationship between literacy and HbA_1c remained whether we treated literacy scores as a categorical variable or as a continuous measure, and did not change after adjustment for potential confounding variables. Similar to a previous study,³ we did find that patients with low literacy had significantly poorer knowledge about the treatment of diabetes. For example, patients with low literacy were less likely to know the treatment of low blood sugar or the normal range of blood glucose levels.

Several factors may explain our discordant findings. We examined only a subgroup of patients . . . [Full Text of this Article]

Tabitha Zimmerman, MD; Donald W. Shenenberger, MD
Naval Medical Center
Portsmouth, Va

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