Article Summary Influence of Patient Literacy on the Effectiveness of a Primary Care–Based Diabetes Disease Management Program. Rothman RL, DeWalt DA, Malone R, Bryant B, Shintani A, Crigler B, Weinberger M, Pignone M. JAMA. 2004;292:1711-1716. Objective: To examine the effect of comprehensive intervention on improved glycemic control in patients with type 2 diabetes and literacy below the sixth-grade level. Methods: This was a small, single-site, randomized controlled trial conducted in a university general internal medicine practice. The study was initiated in February 2001 and completed in April 2003, with all patients receiving follow-up for 1 year. Eligible patients were those who received diabetes care in the general internal medicine practice, had poor glucose control, had A1C >8%, and were English speaking. At the time of enrollment, literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine screen. Prior to randomization, all patients attended a 1-hour educational session that included treatment recommendations. Patients in the control group (n=105) received usual care from their primary care physician (PCP) with no further contact with a disease management team. The intervention group (n=112) received intensive diabetes management that included one-on-one educational sessions, counseling, and medication management by 3 clinical pharmacists and a diabetes care coordinator, in addition to usual PCP care. Patients in this arm were contacted by telephone or in person every 2 to 4 weeks. Communication was generally verbal and individualized to provide simple explanations of treatment goals, symptoms of hypoglycemia and hyperglycemia, and the importance of self-care. Levels of A1C were measured at baseline, 6 months, and 12 months. Results: Patients in the intervention group had significantly greater improvement in A1C levels at 12 months compared with control patients (-2.1% versus -1.2%) and were more likely to reach A1C target levels of <7% than were those in the control group. Conclusion: Patients with type 2 diabetes and low literacy have difficulty learning self-care skills that are necessary for glycemic control. Providing such patients with uncomplicated, appropriate, literacy-level communication and ongoing diabetes management skills improves glycemic control in this population.