Language barriers have mixed effect on diabetes management
medwireNews: Having a physician who speaks their native language is associated with improved glycemic control among diabetes patients with limited English proficiency, but may be less important for medication adherence, research suggests.
Two studies, both published in JAMA Internal Medicine, used data from the Kaiser Permanente Northern California healthcare system to address the effects of concordant native language among Latino patients whose preferred language was Spanish and their physicians.
The study addressing glycemic control involved 1605 such patients whose primary diabetes care provider changed during the study. Patients had an overall improvement in glycemic control following the switch, but the largest improvement occurred among patients who switched from a provider who did not speak Spanish to one who did (about a quarter of the population).
These patients achieved an 11 percentage point improvement in glycemic control, with the proportion of patients with glycated hemoglobin levels below 8% increasing from 63% to 74%. The improvement remained at 10 percentage points after accounting for changes in the reference group of patients who switched between two Spanish-speaking providers.
However, patients did not seem to suffer if they switched from a concordant to a discordant language provider, achieving a nonsignificant 4 percentage point improvement in glycemic control rate. And both groups achieved significant improvements in cholesterol levels and slight improvements in blood pressure, report Andrew Karter (Kaiser Permanente, Oakland, California, USA) and co-researchers.
In an accompanying editorial, Jennifer Alvidrez and Eliseo Pérez-Stable (National Institutes of Health, Bethesda, Maryland, USA) suggest that where the potential for language concordance is limited, it may be worth prioritizing patients with newly diagnosed diabetes, “because language concordance may be more important in establishing a treatment regimen than in maintaining it.”
They add: “When concordance at the time of diabetes diagnosis is not possible, findings from this study suggest that switching to a concordant physician at some point during treatment can improve outcomes, with no apparent detriment for patients gaining a concordant clinician or those losing one.”
In the second study, Alicia Fernández (San Francisco General Hospital, California, USA) and colleagues found that language concordance did not affect whether patients were adherent to newly prescribed diabetes medications.
Based on pharmacy records, they estimated that 6.5% of 3205 Latino patients with limited English proficiency did not take their prescribed medication even once, with 25.7% lapsing after just one prescription refill and 54.2% becoming nonadherent later.
These nonadherence rates were significantly higher than those in 5755 English-speaking Latino patients, at a corresponding 5.3%, 21.9%, and 45.7%, which were higher again than those in 21,878 White patients, at 3.6%, 14.7%, and 32.4%.
The editorialists therefore suggest that factors determining medication adherence among Latino patients may depend less on their ability to speak English and more on “undefined sociocultural components.”
And they speculate that less acculturated patients who struggle with English “may have additional barriers to adherence related to resistance to taking daily medications when ‘feeling well’ that were not addressed by clinicians.”
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