DIABETES

Language may impact diabetes care for Latinos with limited English

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Latino patients with limited English skills may be less likely to take prescribed diabetes medications than other diabetics in the U.S. even when they see Spanish-speaking doctors, a recent study suggests.

When researchers studied 31,000 patients with diabetes who received insurance and healthcare through Kaiser Permanente in Northern California, they found that about 60 percent of Spanish-speaking Latino patients skipped filling prescriptions at least 20 percent of the time in the two years after they were told they needed the drugs to help control the disease.

That rate was only about 52 percent among English-speaking Latino patients and 38 percent among white patients.

"Latino patients with diabetes, even when insured and facing relatively low barriers to healthcare, are much more likely to have poor medication adherence than their white counterparts," said lead study author Dr. Alicia Fernandez, a researcher at San Francisco General Hospital and the University of California, San Francisco.

The study didn't find any difference in medication adherence for diabetics with limited English based on whether they saw Spanish-speaking doctors.

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This suggests factors beyond just language and communication may come into play, researchers conclude in JAMA Internal Medicine.

"Physicians who care for Latino patients with diabetes should focus on medication adherence and explore individual barriers to adherence," Fernandez added by email. "These may include lack of 'buy-in' to medication treatment, concern regarding side effects, concerns regarding costs, and competing life demands on medication use and self-care."

But while this study didn't find that having Spanish-speaking doctors improved medication adherence, a separate study of Latino diabetics published in the same journal did see some benefit.

The researchers on the second study also looked at data from Kaiser Permanente, in this case to see whether patients with limited English proficiency might have better blood sugar control when they switched from English-speaking to Spanish-speaking primary care physicians.

This study included about 1,600 Latino patients who preferred speaking Spanish to English.

At the start of the study, 54 percent of these patients saw a primary care provider who didn't speak Spanish. During the study, 48 percent of this group of patients switched to a Spanish-speaking doctor.

After this switch to Spanish-speaking doctors, 74 percent of these patients had blood sugar in a healthy range, up from 63 percent when they saw English-speaking doctors. This increase was 10 percent more than the patients who just switched from one English-speaking doctor to another.

"Having a primary care provider that speaks your language appears to be important for several reasons; it improves lines of communication, may reduce the risk of misunderstandings, increases patient satisfaction and now there is evidence that it may also improve management of diabetes," said lead study author Melissa Parker, a researcher at Kaiser Permanente in Oakland, California.

Both studies have some limitations, including the lack of data on some factors that can influence how much patients take their medicine or follow advice from doctors, such as health literacy or the degree of spoken or written abilities in English and Spanish for physicians and patients.

Still, the results from these studies suggest that it would make sense to prioritize access to Spanish-speaking doctors for Latinos with limited English who are newly diagnosed with diabetes, Dr. Eliseo Perez-Stable, director of the National Institute on Minority Health and Health Disparities, writes in an accompanying editorial.

That's because seeing a doctor who speaks Spanish may be more important for establishing a treatment regimen than maintaining one, Perez-Stable writes.

"Communication between clinicians and patients is essential in most aspects of medicine but it is especially true in management of a chronic disease such as diabetes," Perez-Stable said by email.

Ideally, there would be more Spanish-speaking and bilingual doctors, Perez-Stable added by email. Absent that, patients should make sure there's a professional interpreter available and also bring someone to clinic visits who is bilingual and can help support the treatment plan after patients go home.