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Associations of literacy with diabetes indicators in older adults
  1. Melissa Lamar1,2,
  2. Robert S Wilson1,2,3,
  3. Lei Yu1,3,
  4. Bryan D James1,4,
  5. Christopher C Stewart2,
  6. David A Bennett1,3,
  7. Patricia A Boyle1,2
  1. 1 Rush Alzheimer’s Disease Center, Chicago, Illinois, USA
  2. 2 Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
  3. 3 Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
  4. 4 Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
  1. Correspondence to Dr Melissa Lamar, Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL 60612, USA; melissa_lamar{at}


Background Literacy, the ability to access, understand and utilise information and concepts from diverse sources in ways that promote good outcomes is key to successful ageing. Domain-specific health and financial literacy are particularly relevant to older adults as they face increasingly complex health and financial demands including those related to chronic conditions like type 2 diabetes. We therefore investigated the associations of literacy, including health and financial literacy, with diabetes indicators (ie, haemoglobin A1c and blood glucose) in a community-based cohort study of ageing.

Methods Participants were 908 non-demented older adults (age ~81 years;75% women) from the Rush Memory and Aging Project. Literacy was measured using questions designed to assess comprehension of health and financial information and concepts and yielded a total score and domain-specific health and financial literacy scores. Non-fasting haemoglobin A1c and blood glucose samples were collected, participants were queried about diabetes status and medications for diabetes were visually inspected and coded. Participants also underwent a cognitive assessment, medical history and depressive symptom screening.

Results In separate multivariable linear regression models, total (p values <0.03) and health (p values <0.009) literacy were inversely associated with haemoglobin A1c and blood glucose levels after adjusting for age, sex, education, hypertension, global cognitive functioning and depressive symptoms. Financial literacy was inversely associated with haemoglobin A1c levels in adjusted models (p=0.04). Sensitivity analyses conducted among individuals without diabetes revealed similar results.

Conclusion Lower literacy levels are associated with higher diabetes indicators, particularly haemoglobin A1c which is suggestive of longer-term glycaemic instability.

  • ageing
  • diabetes
  • health beliefs si
  • decision making pr

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  • Patient consent for publication Not required.

  • Contributors ML, LY and PAB contributed to the planning of the study. ML, LY, BDJ and PAB contributed to the conduct of the study and ML, RSW, LY, BDJ, CCS, DAB and PAB contributed to the reporting of the study and gave final approval of the manuscript.

  • Funding The study was supported by National Institute on Aging (grant number R01AG17917, R01AG34374 and R01AG33678 and K01AG050823).

  • Competing interests None declared.

  • Ethics approval Institutional Review Board of Rush University Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Information regarding obtaining data from the Rush Memory and Aging Project for research use can be found at the RADC Research Resource Sharing Hub (