Abstract

Objectives: Understanding the reasons and eliminating the pervasive health disparities in diabetes is a major research, clinical, and health policy goal. We examined whether health literacy, general numeracy, and diabetes-related numeracy explain the association between African American race and poor glycemic control (A1C) in patients with diabetes.

Research Design and Methods: Adults with Type 2 diabetes (N=383) were enrolled in a cross-sectional study at primary care and diabetes clinics at 3 medical centers. Data collected included: self-reported race, health literacy, general numeracy, diabetes-related numeracy, A1C, and socio-demographic factors. A series of structural equation models were estimated to explore the interrelations between variables, and test for mediation.

Results: In Model 1, younger age (r=−0.21, p<0.001), insulin use (r=0.27, p<0.001), greater years with diabetes (r=0.16, p<0.01), and African American race (r=0.12, p<0.01) were all associated with poorer glycemic control. In Model 2, diabetes-related numeracy emerged as a strong predictor of A1C (r=−0.46, p<0.001), reducing the association between African American and poor glycemic control to non-significance (r=0.10, ns). In Model 3, African American race and older age were associated with lower diabetes-related numeracy; younger age, insulin use, more years with diabetes, and higher diabetes-related numeracy were associated with poorer glycemic control.

Conclusions: Diabetes-related numeracy reduced the explanatory power of African American race, such that low diabetes-related numeracy, not African American race, was significantly related to poor glycemic control. Interventions that address numeracy could help to reduce racial disparities in diabetes.