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• W1486248518 abstract "Current UK practice requires individuals being considered for insulin pump therapy to have been ‘educated’ in the nuances of carbohydrate counting and insulin dose adjustment. This usually means participation in one of a number of structured education programmes [1], followed by additional training on insulin pump use per se, delivered either by nurse educators or the manufacturers of the devices. Device manufacturers also provide manuals and workbooks for patients to support pump initiation. An important component of training for insulin pump therapy requires skills with handling numbers. Numeracy is the ability to understand and use numbers in daily life and having appropriate numeracy skills is important for health in general and specifically for diabetes care [2]. Previously, we have reported that information provided for diabetic patients often has low readability scores, requiring literacy skills well above the average in adults living in the UK [3]. Unfortunately, the UK also has high numbers of adults with low levels of numeracy compared with other countries. In 2003, it was estimated that 23.8 million adults (75% of the adult population of working age) in England had numeracy skills below level 2, equivalent to a good pass at General Certificate of Secondary Education (GCSE) level. An estimated 6.8 million lacked basic (i.e. entry level 3) numeracy, the level recognized by the Government for ‘functional competence for everyday living’. Recently, the UK government has admitted that ‘large numbers of the adult population remain functionally illiterate and innumerate’ [4]. In the USA, almost two in three adults also cannot perform the most rudimentary of quantitative skills and numeracy may be an overlooked factor contributing to racial disparities in glycaemic control [5]. There is no evidence that the UK population with Type 1 diabetes are any different from the background population in terms of their educational attainment. We have examined the workbooks provided by the three main insulin pump manufacturers for patients starting insulin pump therapy and assessed them for the level of numeracy required to understand their content based on the UK Adult Numeracy Core Curriculum [6]. All three manuals demanded the understanding and application of numeracy skills up to level 2, i.e. GCSE grade A*- C in mathematics, and in some cases up to level 3 or above (A-level or higher-tier GCSE). Example 1. In the manual provided by Animas [7]: Sample blood glucose (BG) bolus calculation; BG is below target: If your insulin sensitivity factor (ISF) is 2.8 mmol/l and your target BG is 6 mmol/l, how much is your BG bolus if your BG is 4.5 mmol/l? The division of a negative number requires the application of numeracy skills at level 2. This calculation requires numeracy skills at level 2. Example 3. The images produced by Medtronic [9] to illustrate downloads from insulin pumps and glucose sensors incorporate multiple line graphs, decimal numbers, percentages and pie charts. Analysing and interpreting data from complex charts and trend graphs requires numeracy skills up to level 3, broadly equivalent to a higher-tier GCSE and an A-level in mathematics. Although attempts to simplify the training manuals are likely to engage with a wider patient audience [10], it needs to be remembered that calculation of a percentage increase or decrease requires at least level 1 numeracy. In the UK, uptake of insulin pump therapy for people living with Type 1 diabetes remains modest and, for those established on the device, only a minority use all of the pump features on a regular basis [11]. We believe that there needs to be a radical overhaul of both the technologies and the training around insulin pump initiation, otherwise a number of patients will be excluded or not benefit from the advantages of this form of insulin delivery because of poor numeracy rather than directly as a consequence of their approach to diabetes self-care per se. DK has received honoraria for participating in education events supported by Roche, Animas and Medtronic and research funding from Roche and Medtronic." @default.
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• W1486248518 date "2010-03-30" @default.
• W1486248518 modified "2023-09-25" @default.
• W1486248518 title "Numeracy and insulin pump therapy" @default.
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• W1486248518 doi "https://doi.org/10.1111/j.1464-5491.2010.02999.x" @default.
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