Globalization, immigration and diabetes self-management: an empirical study amongst immigrants with type 2 diabetes mellitus in Ireland

Background: We have previously reported that immigrants in Ireland have poorer glycemic control compared with a matched population of Irish patients. This may be associated with poor diabetes self-care and low health literacy. Aim: To compare the diabetes self-care profile of non-Irish-national patients i.e. immigrant patients (IM) and Irish patients (IR) attending a hospital diabetes clinic and to evaluate differences in health literacy between the two cohorts. Methods: We studied the differences in diabetes self-management between 52 randomly selected non-Irish-national patients with type 2 diabetes and 48 randomly selected Irish/Caucasian patients. Rapid Estimate of Adult Literacy in Medicine (REALM) was used to assess health literacy. Results: IM had poorer glycemic control than IR (HbA1c 8.0 ± 1.9 vs. 6.9 ± 1.4%, P < 0.005). A significant proportion of IM forget to monitor their daily blood glucose (42.1% vs. 12.5%, P < 0.05). Family support is more important amongst IM in performing daily blood glucose monitoring (75% vs. 47.7%, P < 0.05), taking medications (81.7% vs. 42.2%, P = 0.01) and following an appropriate meal plan (87.6% vs. 62.2%, P < 0.05). Fifty-three percent can only understand simple or familiar questions about their diabetes care; 65.9% can only provide information on simple or familiar topics about their diabetes. Health literacy was found to be lower in the IM groups when assessed using REALM (52.7 vs. 61.4, P = 0.01). Conclusion: Those providing diabetes education and care need to be aware of differing patient expectations regarding family involvement in the care of their diabetes and the possible contribution of language problems and lower health literacy to a limited understanding of diabetes self-care.