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Examining health literacy and healthy lifestyle characteristics as associated with glycemic control among community-dwelling Japanese people

Hirohide Yokokawa*, Hiroshi Fukuda, Kazutoshi Fujibayashi, Motoyuki Yuasa, Aki Okamoto, Yoshinobu Taneda, Makio Tani, Kazuhiro Sugimoto, Teruhiko Hisaoka & Toshio Naito

Background: Diabetes mellitus (DM) is strongly associated with long-term micro- and macrovascular complications, necessitating improved glycemic control in order to reduce these complications as well as morbidity and mortality rates. Health literacy (HL) has gained considerable attention and is recognized as an important factor associated with medication adherence and health care behaviors. Few studies have assessed how health literacy (HL) and healthy lifestyle characteristics are associated with glycemic control among Japanese patients with DM.

Methods: The present cross-sectional study population comprised 670 Japanese patients (446 men and 224 women) with DM who visited the Fuchu Clinic and Okamoto Medical Clinic in Tokyo, and the Taneda Medical Clinic, Tani Clinic, and Ohta Nishinouchi Hospital in Fukushima Prefecture, Japan, from December 2016 to December 2017. Selfadministered questionnaires were used to collect information on HL and healthy lifestyle characteristics listed in Breslow’s seven health practices. Medical information was copied from patient medical files.

Results: Multivariate logistic analysis revealed a significant inverse association between the total HL score (≥ 19) and Hemoglobin A1c (Hb A1c) >7.0% compared to the total HL score (≤ 16) [Odds ratio (OR)=0.67, 95% Confidence interval (CI)=0.47-0.96)]. The total number of healthy lifestyle characteristics (≥ 6) was significantly and inversely associated with Hb A1c >7.0% compared to the total number of healthy lifestyle characteristics (≤ 3) in univariate analysis (OR=0.60, 95% CI=0.38-0.95); this significance was not observed after adjustment. Multivariate logistic analysis revealed a significant inverse association between exercise frequency ≥ 2 times per week and Hb A1c >7.0% (OR=0.64, 95% CI=0.47-0.88).

Conclusions: Health literacy and adequate exercise frequency were inversely associated with uncontrolled DM, highlighting the importance of comprehensive assessments including HL, and the necessity of lifestyle modification including physical activity for maintaining better glycemic control in clinical settings.