{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T05:54:09Z","timestamp":1781502849930,"version":"3.54.1"},"reference-count":30,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100020655","name":"European Health and Digital Executive Agency","doi-asserted-by":"publisher","award":["101057730"],"award-info":[{"award-number":["101057730"]}],"id":[{"id":"10.13039\/100020655","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001468","name":"Singapore Eye Research Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001468","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Effective diabetes self\u2010management increasingly depends on the interplay between health literacy, numeracy and digital health literacy, given the growing integration of advanced digital tools into diabetes care routines. Little is known about the current state of these skills among people with insulin\u2010treated diabetes. Therefore, this study aims to assess (digital) health literacy and numeracy in people with diabetes on intensive insulin therapy and to explore their associations with glycaemic control, health behaviours, clinical outcomes and patient\u2010reported outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The\n                      <jats:italic>Exploring Diabetes Health Literacy and Numeracy across Europe<\/jats:italic>\n                      (EDUCATE) study is a multicentre cross\u2010sectional study aiming to recruit 209 adults with type 1, type 2, or pancreatogenic diabetes on intensive insulin therapy in four European outpatient clinics. Participants will be asked to complete questionnaires, record their dietary patterns, and wear both a physical activity tracker and a blinded continuous glucose monitor for two weeks. The primary outcome is health literacy, assessed using the validated Health Literacy questionnaire. Secondary outcomes include numeracy, digital health literacy, glycaemic outcomes, health behaviour (e.g., diet and physical activity), and patient\u2010reported\u2010outcomes (e.g., quality\u2010of\u2010life and diabetes distress).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Findings will be diseminated through peer\u2010reviewed scientific journals, and academic conferences or media outlets to inform the wider public.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>EDUCATE will assess digital health literacy and numeracy in people with diabetes on intensive insulin regimens across four European countries. A deeper understanding of the current landscape of health literacy and its association with glycaemic outcomes may support the development of targeted interventions. These interventions are aimed at empowering people with diabetes and reducing socio\u2010economic and cultural health disparities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dme.70140","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T08:25:19Z","timestamp":1758183919000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Study protocol for exploring diabetes numeracy and health literacy across Europe (\n                    <scp>EDUCATE<\/scp>\n                    ): A multicentre cross\u2010sectional study"],"prefix":"10.1111","volume":"42","author":[{"given":"Elisabeth J.","family":"den Brok","sequence":"first","affiliation":[{"name":"CARIM Cardiovascular Research Institute Maastricht Maastricht University  Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilie","family":"Hornborg\u2010Svensson","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Nephrology Copenhagen University Hospital\u2013North Zealand  Hiller\u00f8d Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nefeli M.","family":"Dimitropoulou","sequence":"additional","affiliation":[{"name":"CARIM Cardiovascular Research Institute Maastricht Maastricht University  Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofie","family":"Broeng\u2010Mikkelgaard","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Nephrology Copenhagen University Hospital\u2013North Zealand  Hiller\u00f8d Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikkel T.","family":"Olsen","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Nephrology Copenhagen University Hospital\u2013North Zealand  Hiller\u00f8d Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lubnaa Abdur","family":"Rahman","sequence":"additional","affiliation":[{"name":"Graduate School for Cellular and Biomedical Sciences University of Bern  Bern Switzerland"},{"name":"ARTORG Center for Biomedical Engineering Research University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Papathanail","sequence":"additional","affiliation":[{"name":"ARTORG Center for Biomedical Engineering Research University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antje","family":"Wiede","sequence":"additional","affiliation":[{"name":"Department of Kidney and Hypertension Diseases, Diabetology and Endocrinology Otto\u2010Von\u2010Guericke\u2010Universit\u00e4t Magdeburg  Magdeburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliane","family":"Peters","sequence":"additional","affiliation":[{"name":"Department of Kidney and Hypertension Diseases, Diabetology and Endocrinology Otto\u2010Von\u2010Guericke\u2010Universit\u00e4t Magdeburg  Magdeburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter R.","family":"Mertens","sequence":"additional","affiliation":[{"name":"Department of Kidney and Hypertension Diseases, Diabetology and Endocrinology Otto\u2010Von\u2010Guericke\u2010Universit\u00e4t Magdeburg  Magdeburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Zikou","sequence":"additional","affiliation":[{"name":"Diabetes Center National and Kapodistrian University of Athens  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Karamanakos","sequence":"additional","affiliation":[{"name":"Diabetes Center National and Kapodistrian University of Athens  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0421-0227","authenticated-orcid":false,"given":"Stavros","family":"Athanasopoulos","sequence":"additional","affiliation":[{"name":"Diabetes Center National and Kapodistrian University of Athens  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asimina","family":"Mitrakou","sequence":"additional","affiliation":[{"name":"Diabetes Center National and Kapodistrian University of Athens  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Makrilakis","sequence":"additional","affiliation":[{"name":"Diabetes Center National and Kapodistrian University of Athens  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sander M. 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