Association between caregiver health literacy and patient characteristics in pediatric new onset diabetes mellitus.

Objectives: This study aimed to describe the health literacy of caregivers of patients with new onset diabetes mellitus (NODM) presenting to a large, pediatric medical center and to describe the association between caregiver health literacy and patient characteristics.

Study design: This was a retrospective, cohort study. Caregiver health literacy was assessed using the Newest Vital Sign (NVS). NVS is scored 0-6: adequate literacy (AL) (4-6); possibility of limited literacy (PLL) (2-3); and high likelihood of limited literacy (HLLL) (0-1).

Methods: Bivariate and multivariable analyses were performed with caregiver health literacy as the predictor. P < 0.05 was considered significant.

Results: Between January 1, 2016 and December 31, 2023, there were 1832 NODM patients [mean age 10.2 (4.8) years, 46 % female]; 1701 (92.8 %) caregivers completed NVS: 92.3 % AL, 5.2 % PLL, and 2.5 % HLLL. Among 1091 diagnosed before January 1, 2023, 561 (51.4 %) and 136 (12.5 %) utilized a continuous glucose monitor (CGM) and insulin pump, respectively, within 12 months. Lower health literacy was associated with higher odds of interpreter use (PLL p < 0.001; HLLL p < 0.001), of tailored diabetes education (PLL p < 0.001; HLLL p < 0.001), and longer length of stay (PLL p < 0.001; HLLL p < 0.001). HLLL (adjusted odds ratio [aOR] 0.25, 95 % confidence interval [CI] 0.06, 0.94) but not PLL (aOR 1.06, 95% CI 0.44, 2.57) was associated with lower odds of CGM use within 12 months.

Conclusions: Patients with NODM whose caregivers have lower health literacy represent a high-risk population associated with increased resource utilization, longer hospitalization, and risk for decreased uptake of diabetes technology. A health-literacy informed approach to initial education may offer opportunities to support the individual needs of caregivers.