Journal of General Internal Medicine

, Volume 33, Issue 4, pp 524–532 | Cite as

Diabetes Mellitus Management Among Patients with Limited English Proficiency: A Systematic Review and Meta-Analysis

  • Jane W. Njeru
  • Mark L. Wieland
  • Gracia Kwete
  • Eugene M. Tan
  • Carmen Radecki Breitkopf
  • Amenah A. Agunwamba
  • Larry J. Prokop
  • M. Hassan Murad
Review Paper

Abstract

Background

Patients with limited English proficiency (LEP) and type 2 diabetes mellitus (T2DM) have several health disparities, including suboptimal patient-provider interactions, poorer glycemic control, and T2DM complications. Understanding existing interventions for improving T2DM outcomes in this population is critical for reducing disparities.

Methods

We performed a systematic review of randomized controlled trials (RCTs) and observational studies examining the effectiveness of interventions in improving T2DM outcomes among patients with LEP in North America. Quality was assessed using the Cochrane risk of bias tool for RCTs and the Newcastle-Ottawa Scale for non-RCT studies. Meta-analysis was conducted using the random-effects model.

Results

Fifty-four studies, 39 of which reported sufficient data for meta-analysis of glycemic control, were included. The interventions were associated with a statistically significant reduction in hemoglobin A1c (HbA1c) (weighted difference in means, −0.84% [95% CI, −0.97 to −0.71]) that was, however, very heterogeneous across studies (I2 = 95.9%). Heterogeneity was explained by study design (lower efficacy in RCTs than non-RCTs) and by intervention length and delivery mode (greater reduction in interventions lasting <6 months or delivered face-to-face); P < 0.05 for all three covariates. The interventions were also associated in most studies with improvement in knowledge, self-efficacy in diabetes management, quality of life, blood pressure, and low-density lipoprotein cholesterol.

Discussion

Multiple types of interventions are available for T2DM management in patients with LEP. Multicomponent interventions delivered face-to-face seem most effective for glycemic control. More research is needed to better understand other aspects of multicomponent interventions that are critical for improving important outcomes among patients with T2DM and LEP.

KEY WORDS

chronic disease diabetes disease management health communication language barriers limited English proficiency 

Notes

Acknowledgments

This publication was made possible by funding from the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

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References

  1. 1.
    Centers for Disease Control and Prevention. US Department of Health and Human Services. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011 [Internet]. Atlanta (GA); 2011 [cited 8 Dec 2016]. Available from: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf.
  2. 2.
    American Diabetes Association. Standards of medical care in diabetes: 2008. Diabetes Care. 2008 31 Suppl 1:S12-54.CrossRefGoogle Scholar
  3. 3.
    Creatore MI, Moineddin R, Booth G, Manuel DH, DesMeules M, McDermott S, et al. Age- and sex-related prevalence of diabetes mellitus among immigrants to Ontario, Canada. CMAJ. 2010 182(8):781-9.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Lanting LC, Joung IM, Mackenbach JP, Lamberts SW, Bootsma AH. Ethnic differences in mortality, end-stage complications, and quality of care among diabetic patients: a review. Diabetes Care 2005 28(9):2280-8.CrossRefPubMedGoogle Scholar
  5. 5.
    Wieland ML, Morrison TB, Cha SS, Rahman AS, Chaudhry R. Diabetes care among Somali immigrants and refugees. J Community Health 2012 37(3):680-4.CrossRefPubMedGoogle Scholar
  6. 6.
    Heisler M, Faul JD, Hayward RA, Langa KM, Blaum C, Weir D. Mechanisms for racial and ethnic disparities in glycemic control in middle-aged and older Americans in the health and retirement study. Arch Intern Med 2007 167(17):1853-60.CrossRefPubMedGoogle Scholar
  7. 7.
    Li K, Wen M. Racial and ethnic disparities in leisure-time physical activity in California: patterns and mechanisms. Race Soc Probl 2013 5(3):147-156.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Schneiderman N, Llabre M, Cowie CC, Barnhart J, Carnethon M, Gallo LC, et al. Prevalence of diabetes among Hispanics/Latinos from diverse backgrounds: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Diabetes Care 2014 37(8):2233-9.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Osborn CY, Cavanaugh K, Wallston KA, Kripalani S, Elasy TA, Rothman RL, et al. Health literacy explains racial disparities in diabetes medication adherence. J Health Commun 2011; 16 Suppl 3:268-78.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Rovner BW, Casten RJ, Harris LF. Sociocultural influences on diabetes self-management behaviors in older African Americans. Diabetes Spectr 2013 26(1):29-33.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Gaskin DJ, Thorpe RJ Jr, McGinty EE, Bower K, Rohde C, Young JH, et al. Disparities in diabetes: the nexus of race, poverty, and place. Am J Public Health 2014 104(11):2147-55.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Pandya C, Batalova J, McHugh M. Limited English proficient individuals in the United States: number, share, growth, and linguistic diversity [Internet]. Washington (DC): Migration Policy Institute; 2011 [cited 2016 Dec 8]. Available from: http://www.migrationinformation.org/integration/LEPdatabrief.pdf.
  13. 13.
    Agency for Healthcare Research and Quality. US Department of Health and Human Services. Medical expenditure panel survey: demographics and health care access and utilization of limited-English-proficient and English-proficient Hispanics [Internet]. Rockville (MD); 2008, Research Findings No. 28 [cited 8 Dec 2016]. Available from: https://meps.ahrq.gov/data_files/publications/rf28/rf28.pdf.
  14. 14.
    DuBard CA, Gizlice Z. Language spoken and differences in health status, access to care, and receipt of preventive services among US Hispanics. Am J Public Health 2008 98(11):2021-8.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Flores G, Tomany-Korman SC. The language spoken at home and disparities in medical and dental health, access to care, and use of services in US children. Pediatrics. 2008 121(6):e1703-14. Erratum in: Pediatrics. 2009 124(4):1265.CrossRefPubMedGoogle Scholar
  16. 16.
    Wilson E, Chen AH, Grumbach K, Wang F, Fernandez A. Effects of limited English proficiency and physician language on health care comprehension. J Gen Intern Med 2005 20(9):800-6.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Murray MD, Tu W, Wu J, Morrow D, Smith F, Brater DC. Factors associated with exacerbation of heart failure include treatment adherence and health literacy skills. Clin Pharmacol Ther 2009 85(6):651-8.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Wisnivesky JP, Krauskopf K, Wolf MS, Wilson EA, Sofianou A, Martynenko M, et al. The association between language proficiency and outcomes of elderly patients with asthma. Ann Allergy Asthma Immunol 2012 109(3):179-84.CrossRefPubMedGoogle Scholar
  19. 19.
    Bauer AM, Chen CN, Alegría M. English language proficiency and mental health service use among Latino and Asian Americans with mental disorders. Med Care 2010 48(12):1097-104.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    John-Baptiste A, Naglie G, Tomlinson G, Alibhai SM, Etchells E, Cheung A, et al. The effect of English language proficiency on length of stay and in-hospital mortality. J Gen Intern Med 2004 19(3):221-8.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Schenker Y, Karter AJ, Schillinger D, Warton EM, Adler NE, Moffet HH, et al. The impact of limited English proficiency and physician language concordance on reports of clinical interactions among patients with diabetes: the DISTANCE study. Patient Educ Couns 2010 81(2):222-8.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Choi S, Lee JA, Rush E. Ethnic and language disparities in diabetes care among California residents. Ethn Dis 2011 21(2):183-9.PubMedGoogle Scholar
  23. 23.
    Flores G. The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev 2005 62(3):255-99.CrossRefPubMedGoogle Scholar
  24. 24.
    Hacker K, Choi YS, Trebino L, Hicks L, Friedman E, Blanchfield B, et al. Exploring the impact of language services on utilization and clinical outcomes for diabetics. PLoS One 2012; 7(6):e38507.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009 6(7):e1000097.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Higgins JPT, Altman DG, Sterne JAC. Assessing risk of bias in included studies. Chapter 8. In: Higgins JPT, Green S, (eds). Cochrane handbook for systematic reviews of interventions. Version 5.1.0; 2011.Google Scholar
  27. 27.
    Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses [Internet]. Ottawa Hospital Research Institute [cited 8 Dec 2016]. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
  28. 28.
    DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986 7(3):177-88.CrossRefPubMedGoogle Scholar
  29. 29.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003 327(7414):557-60.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Balshem H, Helfand M, Schunemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 2011 64(4):401-6.Google Scholar
  31. 31.
    UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998 352(9131):854-65. Erratum in: Lancet 1998 352(9139):1558.Google Scholar
  32. 32.
    Murad MH, Almasri J, Alsawas M, Farah W. Grading the quality of evidence in complex interventions: a guide for evidence-based practitioners. Evid Based Med 2017 22(1):20-2.Google Scholar
  33. 33.
    Renders CM, Valk GD, Griffin SJ, Wagner EH, Van Eijk JT, Assendelft WJ. Interventions to improve the management of diabetes in primary care, outpatient, and community settings: a systematic review. Diabetes Care 2001 24(10):1821-33.Google Scholar
  34. 34.
    McElroy A, Jezewski MA. Cultural variation in the experience of health and illness. In: Albrecht GL, Fitzpatrick R, Scrimshaw SC, editors. The handbook of social studies in health and medicine. Thousand Oaks: Sage Publications Ltd; 2000. p. 191-209.Google Scholar
  35. 35.
    Tabak RG, Sinclair KA, Baumann AA, Racette SB, Sebert Kuhlmann A, Johnson-Jennings MD, et al. A review of diabetes prevention program translations: use of cultural adaptation and implementation research. Transl Behav Med 2015 5(4):401-14.Google Scholar
  36. 36.
    Carter JS, Gilliland SS, Perez GE, Levin S, Broussard BA, Valdez L, et al. Native American Diabetes Project: designing culturally relevant education materials. Diabetes Educ 1997 23(2):133-4, 139.Google Scholar
  37. 37.
    Rychetnik L, Frommer M, Hawe P, Shiell A. Criteria for evaluating evidence on public health interventions. J Epidemiol Community Health 2002 56(2):119-27.Google Scholar
  38. 38.
    Durlak JA, DuPre EP. Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol 2008 41(3-4):327-50.Google Scholar
  39. 39.
    Oakley A, Strange V, Bonell C, Allen E, Stephenson J; RIPPLE Study Team. Process evaluation in randomised controlled trials of complex interventions. BMJ 2006 332(7538):413-6.Google Scholar
  40. 40.
    Kane EP, Collinsworth AW, Schmidt KL, Brown RM, Snead CA, Barnes SA, et al. Improving diabetes care and outcomes with community health workers. Fam Pract 2016 33(5):523-8.Google Scholar
  41. 41.
    Zong J, Batalova, J. The limited English proficient population in the United States [Internet]. Washington (DC): Migration Policy Institute; 2015 [cited 2016 Dec 8]. Available from: http://www.migrationpolicy.org/article/limited-english-proficient-population-united-states.
  42. 42.
    Walker RJ, Strom Williams J, Egede LE. Influence of race, ethnicity and social determinants of health on diabetes outcomes. Am J Med Sci 2016 351(4):366-73.Google Scholar
  43. 43.
    Cosgrove S, Moore-Monroy M, Jenkins C, Castillo SR, Williams C, Parris E, et al. Community health workers as an integral strategy in the REACH US program to eliminate health inequities. Health Promot Pract 2014 15(6):795-802.Google Scholar
  44. 44.
    Cherrington A, Ayala GX, Amick H, Allison J, Corbie-Smith G, Scarinci I. Implementing the community health worker model within diabetes management: challenges and lessons learned from programs across the United States. Diabetes Educ 2008 34(5):824-33.Google Scholar
  45. 45.
    Spiro A, Oo SA, Marable D, Collins JP. A unique model of the community health worker: the MGH Chelsea Community Health Improvement team. Fam Community Health 2012 35(2):147-60.Google Scholar
  46. 46.
    Collinsworth A, Vulimiri M, Snead C, Walton J. Community health workers in primary care practice: redesigning health care delivery systems to extend and improve diabetes care in underserved populations. Health Promot Pract 2014 15(2 Suppl):51S-61S.Google Scholar
  47. 47.
    Gabriel SE, Normand SL. Getting the methods right: the foundation of patient-centered outcomes research. N Engl J Med 2012 367(9):787-90.Google Scholar
  48. 48.
    Njeru JW, Tan EM, St Sauver J, Jacobson DJ, Agunwamba AA, Wilson PM, et al. High rates of diabetes mellitus, pre-diabetes and obesity among Somali immigrants and refugees in Minnesota: a retrospective chart review. J Immigr Minor Health 2016 18(6):1343-9.Google Scholar

Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  • Jane W. Njeru
    • 1
  • Mark L. Wieland
    • 1
  • Gracia Kwete
    • 2
    • 3
  • Eugene M. Tan
    • 4
  • Carmen Radecki Breitkopf
    • 5
  • Amenah A. Agunwamba
    • 6
  • Larry J. Prokop
    • 7
  • M. Hassan Murad
    • 6
    • 8
  1. 1.Division of Primary Care Internal MedicineMayo ClinicRochesterUSA
  2. 2.Mayo Clinic School of MedicineMayo Clinic College of Medicine and ScienceRochesterUSA
  3. 3.Massachusetts General HospitalBostonUSA
  4. 4.Division of Infectious DiseasesMayo ClinicRochesterUSA
  5. 5.Division of Health Care Policy and ResearchMayo ClinicRochesterUSA
  6. 6.Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterUSA
  7. 7.Mayo Medical LibraryMayo ClinicRochesterUSA
  8. 8.Division of Preventive, Occupational, and Aerospace MedicineMayo ClinicRochesterUSA

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