Diabetes Literacy

Seventh Framework Programme European Commission


    The Diabetes Challenge

    Diabetes mellitus is the fourth largest cause of death in the European Union. About 32 million people in the EU live with diabetes, almost 50% of whom are unaware of their condition. Treatment of diabetes is costly: between 5 and 15% of the total health expenditure  of European countries. Diabetes is strongly associated with overweight and obesity. In conjunction with the demographic evolution towards an ageing population the prevalence of diabetes is set to increase in the years to come. In consequence, diabetes treatments will command an even larger proportion of the healthcare expenditures.  

    The capacities of health systems in the EU Member States with regard to prevention of, and treatment and care for diabetes must be strengthened. Many countries have introduced national diabetes strategies or have included diabetes as priority in their health plans. One of the critical success factors of a diabetes strategy is the investment in the self-management capacity of patients. Diabetes requires extensive self-care. The capacities of patients to manage their own illness and care process are considered a key determinant of treatment outcomes. To enhance these capacities, patient education is widely recommended. However, whereas an investment in self-management education would seem an effective way to increase effectiveness and reduce the cost of diabetes care, several questions must be addressed before the large scale implementation of educational interventions can be recommended.

    Major Research Questions 

    Education on self-management has been shown positive outcomes. The cost-effectiveness of these interventions however is not sufficiently substantiated. Also the effectiveness of different educational approaches has not been well researched. Furthermore the success of a diabetes education program also depends on the quality of its implementation, including implementation fidelity, which has hardly been researched at all. The (cost) effectiveness of diabetes self-management education depends on various patient characteristics and contextual conditions. The level of health literacy plays a key role.  While low literacy is likely to impede self-management, its moderating role in improving self-management behaviours in diabetic patients, especially via internet-based programs, has not yet been systematically investigated. Providing patients with literacy-appropriate diabetes education materials may be an effective strategy for imparting skills necessary for diabetes self-management.  The (cost) effectiveness of self-management education also depends on the organization of the health services with among others the availability of health care professionals with multidisciplinary competences, easy access to care for people with diabetes, an efficient information system allowing patient follow-up, and evaluating of the services to strengthen competences and excellence of the services. 

    The Diabetes Literacy project aims to investigate these issues with a view to make suggestions to increase the effectiveness of diabetes self-management education in the EU Member States as part of a comprehensive diabetes strategy at EU level.

    Goal of Diabetes Literacy

    Diabetes Literacy aims to assess and compare the effectiveness and cost-effectiveness of different methods for diabetes self-management education (individual and group education, IT based education, and self-help), assess the implementation fidelity of current diabetes self-management education programs, consider the moderating role of health literacy in self-management education for diabetic patients and develop and test literacy-appropriate diabetes education materials. It will also assess the conditions for effectiveness of self-management education programs in the way the health services are organised.

    Objectives of Diabetes Literacy

    • Perform a systematic and comparative content analysis of the national diabetes strategies and frameworks across all EU Member States;
    • Establish a compendium of diabetes self-management education programs in the EU;
    • Calculate the costs of diabetes education at present on a per person basis at a national level;
    • Assess the relative effectiveness of existing individual, group, and IT based diabetes self-management education and self-help programs;
    • Assess of the moderating impact of low health literacy on the effectiveness of diabetes self-management programs;
    • Assess the role of multidisciplinary competent health professionals, efficient patient follow-up systems, and evaluation of services as conditions for effectiveness of diabetes self-management education programs;
    • Assess the implementation fidelity of current diabetes self-management education programs and the possibility for adaptation to cultural context;
    • Test effectiveness of literacy-appropriate diabetes self-management education materials;
    • Make recommendations for the development of best practice models for diabetes self-management education as part of a comprehensive diabetes strategy at EU level.


    The project has been organised in nine work packages. Please check in the menu item Structure in Consortium for detailed information about the contents and institutions that carry out these work packages.


    The Diabetes Literacy research project is supported by the European Commission under its Seventh Framework Programme for Research (FP7) Grant Agreement number 306186. The project is implemented by a consortium of nine universities and institutions from six EU Member States (Austria, Belgium, Germany, Ireland, the Netherlands and the UK) Israel, the United States and Taiwan. The project started in December 2012 and lasts untill December 2015.