“Language-Concordant” Care Improves Diabetes Control in Latino Patients

For Latino patients with limited English proficiency (LEP), switching to a primary care provider who speaks Spanish is associated with improved control of type 2 diabetes, reports a study in JAMA Internal Medicine.

Using data from the Kaiser Permanente Northern California healthcare system from 2007 through 2013, the researchers analyzed the effects of language-concordant (LC) versus language discordant (LD) care on risk factor control among LEP Latino patients with type 2 diabetes. Of 1605 patients (mean age 60.5 years), about 26% switched from LD to LC care—i.e., from a primary care provider who spoke English only to one who spoke Spanish. Measures of diabetes control for this group were compared to those of patients who remained in LC care (26%), remained in LD care (28%), or switched from an LC to an LD provider (19%).

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Patients who switched from LD to LC care had greater improvement in glycemic control and low-density lipoprotein (LDL) cholesterol, compared to those who remained in LD care. On adjusted analysis accounting for secular trends, the rate of glycemic control (defined as HbA1c less than 8%) increased by 10% among the LD to LC group, while the rate of poor glycemic control (HbA1c greater than 9%) decreased by 4%. Switching from an English-only to a Spanish-speaking primary care provider was also associated with a 9% increase in the rate of LDL control (less than 100 mg/dL). Language concordance had no effect on BP control. There was also a 15% increase in LDL control among patients who switched from LC to LD care. None of the four groups had a reduction in risk factor control after switching from one primary care provider to another.

There are more than 50 million Latinos in the US, 30% to 40% of whom may have LEP. Language discordance between these patients and their healthcare practitioners may pose challenges in providing culturally competent care.

This pre-post study of LEP Latino patients in a large California healthcare system suggests improvements in diabetes risk factor control after switching from a PCP who speaks English only to one who speaks Spanish. Findings include a 10% increase in the prevalence of glycemic control among patients who switch from LD to LC care. Facilitating LC care may be an effective strategy for improving disease control for LEP Latino patients with diabetes [Parker MM, et al. Association of patient-physician language concordance and glycemic control for limited-English proficiency Latinos with type 2 diabetes. JAMA Intern Med 2017; 177:380–387].


April 2017 (Vol 9, Number 4)