{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:21:18Z","timestamp":1792686078412,"version":"4.5.0"},"reference-count":43,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2020,10,15]],"date-time":"2020-10-15T00:00:00Z","timestamp":1602720000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>While the role of medical and nutrition factors on glycemic control among adults with type 2 diabetes mellitus (T2DM) has been well-established, the association between health literacy (H.L.) and glycemic control is inconsistent. This study aims to determine the association of H.L. and nutritional status assessments with glycemic control in adults with type 2 diabetes mellitus. A total of 280 T2DM respondents (mean (SD) age = 49.7 (10.3) years, Glycated hemoglobin (HbA1c) = 9.9 (2.6) %, and Body Mass Index = 32.7 (15.1) kg\/m2) were included in this study. A short-form Test of Functional Health Literacy in Adults (S-TOFHLA) assessed the H.L. levels. Nutritional status assessments included client history, glycemic control, anthropometric, and biochemical data. The mean (S.D.) H.L. score was 45.7 (24.6), with 56% of the respondents had inadequate H.L. Inadequate H.L. was more common among those females; housewives, low education, received oral antidiabetic therapy, and shorter diabetes duration. Respondents with inadequate H.L. were significantly older and had higher HbA1c than those with marginal and adequate H.L. Meanwhile, respondents with inadequate and marginal H.L. levels had significantly higher total cholesterol, LDL-cholesterol, and systolic blood pressure than the respondents with adequate H.L. Low H.L. scores, self-employment status, received dual antidiabetic therapy (insulin with oral agents), received insulin alone, and had higher fasting blood glucose explained about 21% of the total variation in HbA1c (adjusted R2 = 0.21; p &lt; 0.001). Respondents with inadequate H.L. had poor glycemic control. The H.L. scores, together with nutritional status assessments, were the factors that predicted poor glycemic control among adults with T2DM.<\/jats:p>","DOI":"10.3390\/nu12103152","type":"journal-article","created":{"date-parts":[[2020,10,15]],"date-time":"2020-10-15T09:02:03Z","timestamp":1602752523000},"page":"3152","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["Association of Health Literacy and Nutritional Status Assessment with Glycemic Control in Adults with Type 2 Diabetes Mellitus"],"prefix":"10.3390","volume":"12","author":[{"given":"Saman Agad","family":"Hashim","sequence":"first","affiliation":[{"name":"Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia"},{"name":"Sader Teaching Hospital, Basrah Health Directorate, Ministry of Health, Basrah 61001, Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0403-5895","authenticated-orcid":false,"given":"Mohd Yusof","family":"Barakatun-Nisak","sequence":"additional","affiliation":[{"name":"Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia"},{"name":"Institute for Social Sciences Studies, Universiti Putra Malaysia, Serdang 43400, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0614-6700","authenticated-orcid":false,"given":"Hazizi","family":"Abu Saad","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suriani","family":"Ismail","sequence":"additional","affiliation":[{"name":"Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osama","family":"Hamdy","sequence":"additional","affiliation":[{"name":"Joslin Diabetes Centre, Harvard Medical School, Boston, MA 02215, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8083-6024","authenticated-orcid":false,"given":"Abbas Ali","family":"Mansour","sequence":"additional","affiliation":[{"name":"Faiha Specialized Diabetes, Endocrine, and Metabolism Center (FDEMC), University of Basrah, Basrah 61001, Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,10,15]]},"reference":[{"key":"ref_1","unstructured":"International Diabetes Federation (2020, July 27). Diabetes Atlas, Available online: https:\/\/www.diabetesatlas.org\/en\/resources."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"139","DOI":"10.2147\/DMSO.S59652","article-title":"Prevalence of diagnosed and undiagnosed diabetes mellitus in adults aged 19 years and older in Basrah, Iraq","volume":"7","author":"Mansour","year":"2014","journal-title":"Diabetes Metab. Syndr. Obes. Targets Ther."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.dsx.2020.03.008","article-title":"Prevalence and correlation of glycemic control achievement in patients with type 2 diabetes in Iraq: A retrospective analysis of a tertiary care database over a 9-year period","volume":"14","author":"Mansour","year":"2020","journal-title":"Diabetes Metab. Syndr. Clin. Res. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Chetoui, A., Kaoutar, K., Elmoussaoui, S., Boutahar, K., El-Kardoudi, A., Chigr, F., and Najimi, M. (2020). Prevalence and determinants of poor glycaemic control: A cross-sectional study among Moroccan type 2 diabetes patients. Int. Health, 1\u20138.","DOI":"10.1093\/inthealth\/ihz107"},{"key":"ref_5","first-page":"58","article-title":"Predictors of Good Glycemic Controls Among Type 2 Diabetes Mellitus Patients in Two Primary Health Clinics, Kuala Selangor","volume":"15","author":"Abdullah","year":"2019","journal-title":"Malays. J. Med. Health Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1186\/s12902-018-0292-9","article-title":"Glycaemic control for people with type 2 diabetes in Saudi Arabia\u2014An urgent need for a review of management plan","volume":"18","author":"Alramadan","year":"2018","journal-title":"B.M.C. Endocr. Disord."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Gebreyohannes, E.A., Netere, A.K., and Belachew, S.A. (2019). Glycemic control among diabetic patients in Ethiopia: A systematic review and meta-analysis. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0221790"},{"key":"ref_8","first-page":"1","article-title":"Prevalence of Type 2 Diabetes Associated Complications in Kurdistan Region Iraq","volume":"10","author":"Ali","year":"2019","journal-title":"J. Basic Clin. Pharm."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"332","DOI":"10.15218\/zjms.2018.043","article-title":"Glycemic control among type 2 diabetic patients attending the Family Medicine Health Center and the Diabetic Health Center in Erbil, Iraq: A comparative study","volume":"22","author":"Dauod","year":"2018","journal-title":"Zanco J. Med. Sci."},{"key":"ref_10","first-page":"345","article-title":"Glycemic Control among Patients with Type 2 Diabetes Mellitus in Countries of Arabic Gulf","volume":"9","year":"2015","journal-title":"Int. J. Health Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e018281","DOI":"10.1136\/bmjopen-2017-018281","article-title":"Factors associated with health literacy in multimorbid patients in primary care: A cross-sectional study in Switzerland","volume":"8","author":"Pasquier","year":"2018","journal-title":"BMJ Open"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2072","DOI":"10.1016\/j.socscimed.2008.09.050","article-title":"The evolving concept of health literacy","volume":"67","author":"Nutbeam","year":"2008","journal-title":"Soc. Sci. Med."},{"key":"ref_13","first-page":"391","article-title":"Rapid estimate of adult literacy in medicine: A shortened screening instrument","volume":"25","author":"Davis","year":"1993","journal-title":"Fam. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1089\/dia.2011.0070","article-title":"Development and validation of a Spanish diabetes-specific numeracy measure: DNT-15 Latino","volume":"13","author":"White","year":"2011","journal-title":"Diabetes Technol. Ther."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1001\/jama.288.4.475","article-title":"Association of health literacy with diabetes outcomes","volume":"288","author":"Schillinger","year":"2002","journal-title":"JAMA"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1177\/1090198111436341","article-title":"Measuring health literacy in individuals with diabetes: A systematic review and evaluation of available measures","volume":"40","author":"Williams","year":"2013","journal-title":"Health Educ. Behav."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1007\/BF02640361","article-title":"The Test of functional Health Literacy in Adults: A new instrument for measuring patient\u2019s literacy skills","volume":"10","author":"Parker","year":"1995","journal-title":"J. Gen. Intern. Med."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Abdullah, A., Liew, S.M., Salim, H., Ng, C.J., and Chinna, K. (2019). Prevalence of limited health literacy among patients with type 2 diabetes mellitus: A systematic review. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0216402"},{"key":"ref_19","first-page":"65","article-title":"Health Literacy of Diabetic Patients and its Impact on Disease Outcome","volume":"60","author":"Yassin","year":"2018","journal-title":"J. Fac. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2980","DOI":"10.2337\/diacare.27.12.2980","article-title":"Association of health literacy with self-management behavior in patients with diabetes","volume":"27","author":"Kim","year":"2004","journal-title":"Diabetes Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1016\/j.sapharm.2015.02.002","article-title":"Evaluation of instruments to assess health literacy in Arabic language among Iraqis","volume":"11","author":"Sorofman","year":"2015","journal-title":"Res. Soc. Adm. Pharm."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"675","DOI":"10.15537\/smj.2019.7.24277","article-title":"The association of health literacy with glycemic control in Saudi patients with type 2 diabetes","volume":"40","author":"Mashi","year":"2019","journal-title":"Saudi Med. J."},{"key":"ref_23","unstructured":"Daniel, W.W. (2009). Biostatistic a Foundation for Analysis in the Health Sciences, Wiley, John Wiley & Sons, Inc.. [9th ed.]."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/S0738-3991(98)00116-5","article-title":"Development of a brief test to measure functional health literacy","volume":"38","author":"Baker","year":"1999","journal-title":"Patient Educ. Couns."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Wold Health Organization (2004). WHO expert consultation, Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet, 363, 157\u2013163.","DOI":"10.1016\/S0140-6736(03)15268-3"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Amercan Diabetes Association (2020). Standards of Medical Care in Diabetes. Diabetes Care, 43, S1\u2013S2.","DOI":"10.2337\/dc20-S016"},{"key":"ref_27","first-page":"41","article-title":"A Two-Step Approach for Transforming Continuous Variables to Normal: Implications and Recommendations for I.S. Research","volume":"28","author":"Templeton","year":"2011","journal-title":"Commun. Assoc. Inf. Syst."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"874","DOI":"10.2337\/dc07-1932","article-title":"Measuring functional, communicative, and critical health literacy among diabetic patients","volume":"31","author":"Ishikawa","year":"2008","journal-title":"Diabetes Care"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1186\/s12913-018-3197-4","article-title":"The role of health literacy in explaining the association between educational attainment and the use of out-of-hours primary care services in chronically ill people: A survey study","volume":"18","author":"Jansen","year":"2018","journal-title":"B.M.C. Health Serv. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s13098-020-0519-6","article-title":"Health literacy and glycemic control in patients with diabetes: A tertiary care center study in Brazil","volume":"12","author":"Gomes","year":"2020","journal-title":"Diabetol. Metab. Syndr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.puhe.2017.12.005","article-title":"Impact of health literacy on diabetes outcomes: A cross-sectional study from Lahore, Pakistan","volume":"156","author":"Saeed","year":"2018","journal-title":"Public Health"},{"key":"ref_32","first-page":"14","article-title":"Health Literacy among Patients with Diabetes Mellitus Type 2 in Northeast Area of Iran","volume":"3","author":"Salimi","year":"2017","journal-title":"Int. J. Health Stud."},{"key":"ref_33","first-page":"89","article-title":"Factors Associated with Glycaemic Control among Type 2 Diabetes Mellitus Patients","volume":"3","author":"Wan","year":"2016","journal-title":"Int. J. Public Health Clin. Sci."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"85","DOI":"10.5271\/sjweh.769","article-title":"Is job strain a major source of cardiovascular disease risk?","volume":"30","author":"Belkic","year":"2004","journal-title":"Scand. J. Work. Environ. Health"},{"key":"ref_35","first-page":"525","article-title":"Medication adherence in patients with type 2 diabetes mellitus treated at primary health clinics in Malaysia","volume":"7","author":"Ahmad","year":"2013","journal-title":"Patient Prefer. Adherence"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1111\/jdi.12175","article-title":"Factors associated with good glycemic control among patients with type 2 diabetes mellitus","volume":"5","author":"Ahmad","year":"2014","journal-title":"J. Diabetes Investig."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/1472-6823-13-18","article-title":"Younger adult type 2 diabetic patients have poorer glycaemic control: A cross-sectional study in a primary care setting in Singapore","volume":"13","author":"Quah","year":"2013","journal-title":"B.M.C. Endocr. Disord."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.jdiacomp.2008.12.008","article-title":"Factors associated with poor glycemic control among patients with type 2 diabetes","volume":"24","author":"Khattab","year":"2010","journal-title":"J. Diabetes Its Complicat."},{"key":"ref_39","first-page":"187","article-title":"A Comparison of HbA1c and Fasting Blood Sugar Tests in General Population","volume":"1","author":"Ghazanfari","year":"2010","journal-title":"Int. J. Prev. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1161\/CIR.0000000000000579","article-title":"Health Literacy and Cardiovascular Disease: Fundamental Relevance to Primary and Secondary Prevention: A Scientific Statement From the American Heart Association","volume":"138","author":"Magnani","year":"2018","journal-title":"Circulation"},{"key":"ref_41","first-page":"30","article-title":"Health literacy in patients with type 2 diabetes: A cross-sectional study using the HLS-EU-Q47 questionnaire","volume":"45","year":"2019","journal-title":"Semergen"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"4180","DOI":"10.1136\/bmjopen-2013-004180","article-title":"Functional health literacy and glycaemic control in older adults with type 2 diabetes: A cross-sectional study","volume":"4","author":"Souza","year":"2014","journal-title":"BMJ Open"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1093\/heapro\/dah609","article-title":"Understanding health literacy: An expanded model","volume":"20","author":"Zarcadoolas","year":"2005","journal-title":"Health Promot. 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