Researchers across Europe are studying whether people with diabetes who use insulin pumps or multiple daily injections have the skills they need to manage their condition. The study, called EDUCATE, will look at how well people understand health information, work with numbers, and use digital tools like apps and glucose monitors. By surveying about 209 people with diabetes across four European countries, scientists hope to discover which skills matter most for keeping blood sugar levels healthy. Understanding these connections could help doctors create better training programs tailored to what people actually need to succeed with their diabetes care.

The Quick Take

  • What they studied: Whether people with diabetes who use intensive insulin therapy (multiple injections or pumps daily) have the skills to understand health information, work with numbers, and use digital health tools—and how these skills connect to their blood sugar control and overall health.
  • Who participated: About 209 adults with type 1 diabetes, type 2 diabetes, or diabetes caused by pancreas problems, all using intensive insulin therapy, from four different hospitals or clinics across Europe.
  • Key finding: This is a study protocol (a plan for research), not yet completed. Researchers will measure health literacy, numeracy skills, and digital health literacy to see how they relate to blood sugar control, eating habits, exercise, and quality of life.
  • What it means for you: If you or someone you know uses insulin therapy, this research may eventually help doctors identify which skills are most important for managing diabetes well. Results could lead to better training programs designed specifically for what people actually struggle with.

The Research Details

The EDUCATE study is a cross-sectional study, which means researchers will collect information from people at one point in time rather than following them over months or years. They’re recruiting 209 adults with diabetes who use intensive insulin therapy (either multiple daily injections or insulin pumps) from four hospital clinics across Europe. Each person will complete questionnaires about their health literacy (understanding health information), numeracy (working with numbers), and digital health literacy (using health apps and devices). Participants will also keep food diaries, wear activity trackers for two weeks, and use a special glucose monitor that measures blood sugar continuously without needing finger pricks. This combination of surveys and real-world measurements will give researchers a complete picture of each person’s skills and health outcomes.

Understanding what skills people with diabetes actually have is crucial because managing diabetes requires reading medication labels, understanding blood sugar numbers, calculating carbohydrates, and increasingly, using apps and digital devices. If researchers can identify which skills matter most for good health outcomes, doctors can create targeted training programs instead of one-size-fits-all education. This approach could reduce health disparities—meaning it could help ensure that people from different backgrounds and education levels all get the support they need.

This is a study protocol (a detailed plan) rather than completed research, so results aren’t available yet. The study uses validated questionnaires, which means the tools have been tested and proven reliable by other researchers. The inclusion of objective measurements (activity trackers and continuous glucose monitors) rather than just self-reported information strengthens the study. However, because it’s cross-sectional (one point in time), it can show connections between skills and health outcomes but cannot prove that one causes the other. The relatively small sample size (209 people) and focus on European clinics means results may not apply to all people with diabetes worldwide.

What the Results Show

This is a study protocol, meaning the research hasn’t been completed yet and results are not available. The primary outcome the researchers will measure is health literacy—how well people understand health information—using a validated questionnaire called the Health Literacy Questionnaire. Researchers will assess this in people with diabetes who use intensive insulin therapy across four European countries. Once data collection is complete, they will analyze whether people with better health literacy also have better blood sugar control and healthier behaviors.

Beyond health literacy, researchers will also examine numeracy (ability to work with numbers and percentages), digital health literacy (comfort using health apps and devices), blood sugar control measured by a standard test called HbA1c, eating patterns, physical activity levels, quality of life, and diabetes-related stress. They’ll look for connections between all these factors to understand the complete picture of how skills relate to health outcomes.

Previous research suggests that health literacy and numeracy are important for managing chronic diseases, but little is known specifically about people with type 1 diabetes or those using intensive insulin therapy. Most existing studies focus on type 2 diabetes or general populations. This study fills that gap by specifically examining people who use insulin pumps or multiple daily injections, which require more complex decision-making and number skills than other diabetes treatments.

Because this is a study protocol (not yet completed), we cannot discuss actual limitations of results. However, potential limitations include: the study only includes people from four European clinics, so results may not apply to people in other regions; people who volunteer for studies may be different from those who don’t; the two-week measurement period may not represent typical patterns; and cross-sectional design means researchers cannot determine if poor skills cause poor health outcomes or if other factors are involved.

The Bottom Line

This research is still in the planning stage, so no clinical recommendations can be made yet. However, the study suggests that people using insulin therapy should consider evaluating their own skills in three areas: understanding health information, working with numbers, and using digital health tools. If you struggle in any of these areas, discussing this with your diabetes educator or doctor may help identify resources or training that could improve your diabetes management.

This research is most relevant to people with type 1 diabetes or those using insulin pumps or multiple daily injections. It’s also important for diabetes educators, doctors, and healthcare systems designing training programs. People with type 2 diabetes managed with pills or lifestyle changes alone may find some information useful but shouldn’t assume all findings apply to them. Healthcare policymakers interested in reducing health disparities should pay attention to this research.

This is a study protocol, so results won’t be available immediately. Data collection will take several months, followed by analysis and publication, likely within 1-2 years. Any changes to diabetes management based on these findings would come after results are published and reviewed by the medical community.

Want to Apply This Research?

  • Once results are available, users could track their understanding of key diabetes numbers: blood sugar targets, carbohydrate counts per meal, and insulin-to-carb ratios. A simple weekly quiz or self-assessment could measure confidence with these concepts.
  • Users could set a goal to learn one new diabetes skill per week—such as understanding what HbA1c means, learning to count carbohydrates, or exploring a new diabetes app feature. The app could provide short educational videos or articles matched to their skill level.
  • Apps could periodically assess user confidence with health literacy and numeracy through optional check-ins, then suggest relevant educational content based on identified gaps. This personalized approach would mirror the study’s goal of targeted interventions.

This article describes a research study protocol that has not yet been completed. No clinical findings or recommendations are available at this time. If you have diabetes and use insulin therapy, continue following your doctor’s treatment plan and speak with your healthcare team before making any changes to your diabetes management. This information is educational only and should not replace professional medical advice. The study will eventually provide valuable information, but individual results may vary based on personal circumstances.