Müller Frank, Holman Harland, Bhangu Nikita, Kottutt Jepkoech, Azhary Hend, Alshaarawy Omayma
Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, 49503, USA.
Spectrum Health Family Medicine Residency Clinic, Grand Rapids, MI, 49503, USA.
J Gen Intern Med. 2025 Jun;40(8):1803-1810. doi: 10.1007/s11606-025-09385-x. Epub 2025 Jan 28.
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).
To assess the use of antihyperglycemic medications and estimate their impact on glycemic control by LEP status.
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.
Data from the US National Health and Nutrition Examination Survey (NHANES 2003-2018).
Selected language for interview or interpreter request (main exposure). Outcomes include prescribed antihyperglycemic medications and glycemic control (HBA1c).
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.
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.
语言障碍会影响药物疾病管理，导致美国有限英语能力（LEP）的糖尿病（DM）患者之间出现潜在的健康差异。
评估抗高血糖药物的使用情况，并根据LEP状态估计其对血糖控制的影响。
横断面设计。我们应用广义线性模型并对社会人口统计学变量进行调整，比较了说英语和LEP（即说西班牙语或需要口译服务）的糖尿病患者所开具的抗高血糖药物类别及其对血糖控制的影响。
来自美国国家健康与营养检查调查（2003 - 2018年NHANES）的数据。
访谈所选语言或口译需求（主要暴露因素）。结果包括所开具的抗高血糖药物和血糖控制情况（糖化血红蛋白）。
对4666名糖尿病患者的数据进行了分析。LEP和说英语的糖尿病患者使用抗高血糖药物的情况相似，但胰岛素除外，LEP患者使用胰岛素的频率较低。尽管使用的药物相似，但与说英语的糖尿病患者相比，使用双胍类和噻唑烷二酮类药物的LEP患者达到血糖目标水平的可能性较小（调整后的优势比在1.7至3.3之间）。
我们的研究结果表明，LEP患者糖尿病结局的差异可能归因于药物处方以外的因素。这些因素可能包括文化信仰、饮食调整和医疗保健中的沟通障碍。加强患者教育、认可文化习俗以及改善语言服务可能会减轻这些差异。
