Background: Health literacy is considered a determinant of self-management behaviors and health outcomes among people with diabetes. The assessment of health literacy is central to understanding the health needs of a population. This study aimed to adapt the Health Literacy Questionnaire (HLQ) to the Portuguese context and to examine the psychometric properties of a population of people with diabetes. Methods: Data were collected using a self-administrated questionnaire from 453 people with diabetes in a specialized diabetes care unit. Analysis included item difficulty level, composite scale reliability, and confirmatory factor analysis (CFA). Results: The HLQ showed that the items were easily understood by participants. Composite reliability ranged from 0.74 to 0.83. A nine-factor CFA model was fitted to the 44 items. Given the very restricted model, the fit was quite satisfactory [χ²_wlsmv = 2147.3 (df = 866), p = 0.001; CFI = 0.931, TLI = 0.925, RMSEA = 0.057 (90% C.I. 0.054–0.060), and WRMR = 1.528]. Conclusion: The Portuguese version of the HLQ has shown satisfactory psychometric properties across its nine separate scales in people with diabetes. Given the strong observed properties of the HLQ across cultures, languages, and diseases, the HLQ is likely to be a useful tool in a range of Portuguese settings.

Introduction: The increasing burden of diabetes poses a great challenge to healthcare systems and economy worldwide. Although modern therapeutic strategies for diabetes are widely available, most patients still fail to achieve optimal clinical targets and well-being. The primary objective of this study was to assess and explore potential drivers and successful management of diabetes among people with diabetes, family members and healthcare professionals in Portugal, by applying the protocol of the multinational study “Diabetes, Attitudes, Wishes and Needs (DAWN2)”. Material and Methods: A total of 767 adults, including 417 people with diabetes, 123 family members and 227 healthcare professionals, participated in the study. Surveys assessed health-related quality of life, self-management, attitudes/beliefs, social support and priorities for improvement areas in diabetes care. Results: Diabetes has a negative impact on the physical health and emotional well-being of patients in Portugal and is also a psychological burden for family members. Earlier diagnosis and treatment of diabetes were mentioned as a major area of improvement. Healthcare professionals indicated the need for diabetes self-management education. Conclusion: We have used for the first time in Portugal the DAWN2 protocol to address the wishes, needs, and attitudes of Portuguese diabetes patients, their relatives, and healthcare professionals regarding the disease.

Este estudo avaliou o empoderamento de pessoas com diabetes em uso de insulina, atendidas em uma unidade básica de saúde na capital do Brasil, utilizando o Diabetes Empowerment Scale – Short Form (DES-SF). Trata-se de um estudo transversal quantitativo realizado com 221 participantes (mediana de idade 61 anos), com foco em avaliar o empoderamento no autocuidado da diabetes. A amostra foi composta, em sua maioria, por mulheres (58,4%) e de participantes com baixa escolaridade, sendo 67,0% com menos de oito anos de estudo. Os dados indicaram pontuação média moderada (3,65 ± 1,18) no DES-SF. Pessoas do sexo masculino e com maior escolaridade apresentaram maiores pontuações, enquanto a idade mais avançada mostrou relação inversa com os escores, ambas as variáveis demonstraram significância estatística. No entanto, não foi identificada associação entre os escores do DES-SF e os níveis de hemoglobina glicada. O estudo sugere que o empoderamento no autocuidado pode ser aprimorado, promovendo melhores desfechos clínicos. A compreensão do empoderamento orienta a prática profissional e políticas de saúde, visando melhorar a qualidade de vida das pessoas.

Background: Hypoglycaemias represent a frequent acute complication in people with type 2 diabetes on insulin regimens, potentiated by symptoms, associated complications and quality of life reduction. Additionally, frequent episodes and inadequate treatment contribute to a gradual reduction of the ability to perceive hypos. Objective: To identify the occurrence of perceived and unperceived hypoglycaemias in persons with type 2 diabetes on insulin, especially through the use of a continuous glucose monitoring system (CGMS) device, the possible causes for the perceived episodes, and followed treatment. Methods People with type 2 diabetes used CGMS during 7 days, filling in data related with hypoglycaemias occurrence, including recorded glycaemia values, symptoms, estimated causes treatment and the need to get help from others. Results: The participating people with type 2 diabetes (n=60) had a mean age of 60.8±0.9 years, and a mean HbA1c of 7.5±0.1% (58 mmol/mol). One third of the participants reported hypoglycaemia symptoms, identifying 42 situations. 57% of those were confirmed by capillary glucose measurement, 17% were related only with symptoms, and 26% were pseudo-hypoglycaemias. Regarding these documented hypoglycaemias, the most common symptoms were: tremors (63%), visual difficulties (33%), perspiration (29%), hunger (17%), and heat (17%). On the other hand, 45% of participants had 89 episodes of non-perceived hypoglycaemias, of which 15% were of level 2 (≤54mg/dl). We identified non-perceived hypoglycaemias in both people who reported hypoglycaemia symptoms (56%) and people who didn´t report hypoglycaemia symptoms (40%). The causes reported by participants were related with intense or unexpected physical activity (23%), delay between meals (8%), less carbohydrate ingestion at last meal (8%), and excess of insulin administration (8%). Participants were not able to identify any cause in 42% of hypoglycaemia episodes. Taking into account hypoglycaemia therapeutic guidelines, we observed that only 50% were treated accordingly to recommendations (namely, glucose ingestion). Conclusion: A considerable proportion of non-perceived hypoglycaemias was uncovered through the CGMS, in people with type 2 diabetes on insulin, with or without perceived hypoglycaemias. Furthermore, half of the situations where the hypoglycaemia episode was symptomatic were treated in a less than adequate way. Funding Information: This research was supported by the Portuguese NovoNordisk. Declaration of Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Ethics Approval Statement: Ethical and regulatory approvals were obtained from the local Ethics Committee at APDP (117/2017).

Diabetes is a chronic and challenging disease and requires personal daily self-management decisions and skills. For that, it is necessary that patients have sufficient information and health literacy to make the right choices and decisions in their self-care. Sequentially, health literacy has great relevance and influence in the daily lives of people with diabetes, since it encompasses the necessary skills to manage disease and health. Health literacy can be a relevant factor to consider when tackling diabetes self-management. Thus, for the prevention and treatment of diabetes, it is essential to promote individual health literacy. The quality of communication and patient-centred communication style seems to be a key aspect for the health literacy.