Medication Adherence for Diabetes Less Likely Among Latinos with Limited English

Language barriers among Latino patients may impact diabetes care, even when seeing Spanish-speaking physicians.

In a study published inJAMA Internal Medicine, investigators examined 31,000 patients with diabetes who received insurance and health care through Kaiser Permanente in Northern California.

The results of the study showed that approximately 60% of Spanish-speaking Latino patients skipped out on filling their prescriptions at least 20% of the time in 2 years. This rate was only 52% among English-speaking Latino patients, and 38% among white patients.

“Latino patients with diabetes, even when insured and facing relatively low barriers to health care, are much more likely to have poor medication adherence than their white counterparts,” said lead author Dr. Alicia Fernandez.

Additionally, no differences were observed in medication adherence for Spanish-speaking patients with limited English based on whether they saw Spanish-speaking physicians.

“Physicians who care for Latino patients with diabetes should focus on medication adherence and explore individual barriers to adherence,” Dr. Fernandez said. “These may include lack of ‘buy-in’ to medication treatment, concern regarding side effects, concerns regarding costs, and completing life demands on medication use and self-care.”

Although the study did not find that Spanish-speaking physicians improved adherence, a second study did see some benefit for Latinos withdiabetes.

Approximately 1600 Latino patients who favored speaking Spanish over English were included in the second study.

Data obtained from Kaiser Permanente were used to determine whether patients with limited English proficiency might have better glucose control when switched from English-speaking primary care physicians (PCPs) to Spanish-speaking PCPs.

At the beginning of the study, 54% of patients went to a PCP who did not speak Spanish. During the study, 48% switched to a Spanish-speaking PCP.

The results of the study showed that after the switch, 74% of Spanish-speaking patients had blood glucose in the healthy range compared to 63% who saw English-speaking physicians. The increase was 10% more than patients who switched from one English-speaking physician 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 misunderstanding, increases patient satisfaction, and now there is evidence that it may also improve management of diabetes,” said lead author Melissa Parker.

A limitation to both studies was the lack of data on factors that may influence how often patients are adherent to their medications or follow their physicians’ advice, such as health literacy or the degree of spoken or written abilities in English and Spanish for physicians and patients.

Despite the limitations, the findings suggest that access to Spanish-speaking physicians for Latinos with limited English who are newly diagnosed with diabetes should be prioritize, Dr. Eliseo Pérez-Stable wrote in an accompanying editorial.

“Communication between clinicians and patients is essential in most aspects of medicine, but it is especially true in the management of a chronic disease such as diabetes,” Pérez-Stable said.

Pérez-Stable recommends that patients ensure there’s a professional interpreter available during appointments, and also that they bring someone to clinic visits who is bilingual and can help support the treatment plan after the patient goes home.