Self-monitoring of blood glucose with finger tip versus alternative site sampling: effect on glycemic control in insulin-using patients with type 2 diabetes.

OBJECTIVE: This study compared glycemic control in finger tip versus forearm sampling methods of self-monitoring of blood glucose (SMBG). RESEARCH DESIGN AND METHODS: One hundred seventy-four insulin-using patients with type 2 diabetes were randomized to SMBG using either finger-tip testing (FT) or forearm alternative site testing (AST) and followed up for 7 months. Hemoglobin A1C (HbA1C) was measured at baseline, month 4, and month 7. The study was designed to test the noninferiority of the AST method for the primary end point of change in HbA1C from baseline to month 7. Adherence with the testing schedule and frequency of hypoglycemic episodes were also measured. RESULTS: The FT (n = 85) and AST (n = 89) groups each had significant decreases in mean HbA1C from baseline to month 7 (FT, -0.4 +/- 1.4%, P = 0.008; AST, -0.3 +/- 1.2%, P = 0.045), and noninferiority between groups was demonstrated with a margin of equivalence of 0.5 (P = 0.043). There was no observable difference in HbA1C change between the groups (P = 0.442). Adherence was better in the FT (87%) than the AST (78%) group (P = 0.003), which may have been because of the difficulty some subjects had in obtaining blood samples for AST. The number of hypoglycemic episodes was too small to assess for a difference between groups. CONCLUSIONS: SMBG by the AST, rather than FT, method did not have a detrimental effect on long-term glycemic control in insulin-using patients with type 2 diabetes. Although adherence with testing was expected to be better in the AST group, it was actually better in the FT group.

Limited literacy and psychiatric disorders among users of an urban safety-net hospital's mental health outpatient clinic.

Little is known about the relationship between mental illness and literacy despite both being prevalent problems. We examine whether literacy varies by psychiatric diagnoses. Interviews and chart reviews (N = 100) were conducted in a behavioral health outpatient clinic. The relationships among sociodemographics, rapid estimate of adult literacy in medicine, measures of verbal and visual intellectual abilities, and psychiatric diagnoses were examined. The mean rapid estimate of adult literacy in medicine score was 55.9 which is equivalent to below an eighth grade literacy level. Psychotic disorder (p = 0.03) was associated with limited literacy, and substance abuse (p = 0.003) and PTSD (p = 0.07) were associated with higher literacy in bivariate analyses. These diagnoses were further examined in multivariate models. Limitations include the small sample size and the over-representation of people with high levels of education. Increasing our understanding of the relationships between health literacy and psychiatric disorders will help inform the development of appropriate psychiatric care and better outcomes.

The role of numeracy on cancer screening among urban women.

OBJECTIVES: To determine the role of numeracy on cancer screening knowledge and practices among an ethnically diverse population. METHODS: Women aged 40+ presenting for primary care at an urban academic medical center were surveyed. Numeracy was measured as a dichotomous outcome (numerate: yes/no) using 3 criteria adapted from a validated instrument. Self-report was used to determine if women were upto-date with breast and colorectal cancer screening. RESULTS: Adequate numeracy was associated with increasing age, white race, higher education, and knowledge of breast cancer screening guidelines. No association was found between numeracy and cancer screening practices. CONCLUSIONS: Adequate numeracy was not a key determinant of cancer screening.

The effect of a primary care exercise intervention for rural women.

OBJECTIVE: Rural women have limited exercise opportunities and significant barriers to engaging in physical activity. This study assessed the effect of a brief primary care based walking intervention in rural women. METHODS: The participants were recruited in March, 2003 by a primary care nurse at three locations in rural Missouri. The enrolled subjects were given a pedometer, exercise videotape and provided exercise counseling at intake and four time points over 6 months. The week 1 pedometer step counts were compared with step counts at 6-month follow-up. RESULTS: Of the initial 75 participants, 61 completed at least one follow up encounter. The participant's mean age was 42.5 years. At intake, the majority of women (90%) exhibited one or more risk factors for cardiovascular disease; 78% were obese or overweight. Although most (62%) women reported being physically active, the mean pedometer reading was low at 6337 steps per day at week 1. Over the follow-up period, participants increased their step counts by a mean of 2573 steps per day (p<.001). Increases in step counts were seen in normal weight, overweight and obese participants. CONCLUSIONS: A simple walking intervention through a primary care practice was effective in increasing the short term walking rates of rural women.