Abstract

Background

Language barriers can impact pharmaceutical disease management leading to potential health disparities among limited English proficiency (LEP) people with diabetes mellitus (DM) in the United States (US).

Objective

To assess the use of antihyperglycemic medications and estimate their impact on glycemic control by LEP status.

Design

Cross-sectional design. We compared the classes of prescribed antihyperglycemic medications and their impact on glycemic control between English-speaking and LEP participants (i.e., Spanish-speaking or needing interpretation services) with DM applying generalized linear models and adjusting for sociodemographic variables.

Participants

Data from the US National Health and Nutrition Examination Survey (NHANES 2003–2018).

Main Measures

Selected language for interview or interpreter request (main exposure). Outcomes include prescribed antihyperglycemic medications and glycemic control (HBA1c).

Key Results

Data for 4666 participants with DM were analyzed. Antihyperglycemic medications were similarly used by LEP and English-speaking people with DM, except for insulin, which was less frequently used by LEP people. Despite similar medications, LEP people using biguanides and TZDs were less likely to reach glycemic target levels (adjusted odds ratios ranging 1.7 to 3.3) compared to English-speaking people with DM.

Conclusions

Our findings indicate that the differences in DM outcomes among LEP people are likely attributed to factors other than medication prescription. These might include cultural beliefs, dietary adjustments, and communication barriers in healthcare. Enhanced patient education, acknowledgment of cultural practices, and improved language services could potentially mitigate these disparities.

Topic

JGIM

Author Descriptions

Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, 49503, USA
Frank Müller MD, PhD, Harland Holman MD, Nikita Bhangu BSc & Jepkoech Kottutt MPH

Spectrum Health Family Medicine Residency Clinic, Grand Rapids, MI, 49503, USA
Frank Müller MD, PhD & Harland Holman MD

Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
Frank Müller MD, PhD

Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, 48824, USA
Hend Azhary MD & Omayma Alshaarawy PhD

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