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48. Factors Affecting Diabetes Knowledge in Insulin-Treated Veterans With Type II Diabetes Mellitus

KD Adam, New Mexico VA Health Care System; C Dalton, Southern Arizona VA Health Care System; GH Murata, New Mexico VA Health Care System; CS Wendel, Southern Arizona VA Health Care System; WC Duckworth, Carl T. Hayden Medical Center; SU Bokhari, Carl T. Hayden Medical Center; MT Montagnini, Carl T Hayden Medical Center; JH Shah, Southern Arizona VA Health Care System

Objectives: Patient education is an integral part of the management program for patients with type II diabetes mellitus. The purpose of this study was to evaluate the factors affecting the performance of the insulin-treated veterans on a standardized test of diabetes knowledge.

Methods: Prospective subjects were randomly drawn from a sample frame derived from pharmacy records at the Albuquerque, Phoenix, and Tucson VAMCs. Consenting patients were interviewed and given a battery of questionnaires. Fund of knowledge was assessed by the University of Michigan Diabetes Knowledge Test. Cognitive functioning was evaluated by the Mini-Mental Status Exam. The Geriatric Depression Scale was used to rate the severity of depression.

Results: One hundred seventy patients completed the protocol. The mean age (+/- SD) was 64.6 +/- 10.2 years, and 4% were women. Preferred language was English for 163 (95%), Spanish for 5 (3%), and Native American for 1 subject. Overall performance on the diabetes knowledge test was poor. Correct answers were given on only 65.0 +/- 14.9% of the 23 questions. The knowledge score was positively correlated with the Mini-Mental Status score (Spearman rho=.32; P<.001) and years of education (r=.314; P<.001) and negatively correlated with age (r= -.333; P<.001) and depression score (Spearman rho= -.17, P=.02). Subjects who preferred English language scored significantly better than those who did not (65.6 +/- 14.4% vs. 45.9 +/- 18.6%; P=.001); however, the predominant language spoken in the home did not affect performance on the knowledge test. Hispanic patients answered fewer questions correctly than non-Hispanic whites (59.9 +/- 14.4 vs. 66.6 +/- 14.2%; P=.02). We found no relationship between diabetes knowledge and duration of diabetes or alcohol consumption. Stepwise multiple linear regression showed that age, Mini-Mental Status score, years of education, Geriatric Depression score, and preference for the English language were independent determinants of the knowledge score (r=.547; P<.001). Once these factors were considered, ethnicity had no effect.

Conclusions: Language preference, years of education, depression and cognitive functioning are significant determinants of diabetes knowledge in insulin-treated veterans with type II diabetes mellitus.

Impact: Language preference, age, years of formal education, depression and cognitive functioning, which are not considered in diabetes education programs, explained 30% of the variation in diabetes knowledge. These factors should be assessed along with learning barriers before veterans are enrolled in VA diabetes education programs. There should be provisions made for those individuals who speak English but prefer to learn either verbally or by audiovisual materials in Spanish.