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Meta-Analysis
. 2018 Apr;33(4):524-532.
doi: 10.1007/s11606-017-4237-1. Epub 2017 Dec 18.

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

Jane W Njeru  1 , Mark L Wieland  2 , Gracia Kwete  3   4 , Eugene M Tan  5 , Carmen Radecki Breitkopf  6 , Amenah A Agunwamba  7 , Larry J Prokop  8 , M Hassan Murad  7   9
Affiliations
Meta-Analysis

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

Jane W Njeru et al. J Gen Intern Med. 2018 Apr.

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.

Keywords: chronic disease; diabetes; disease management; health communication; language barriers; limited English proficiency.

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Conflict of interest statement

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

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
HbA1c improvement: random-effects meta-analysis. Dark circles represent the HbA1c change in individual studies; lines are 95% confidence intervals. The diamond represents the pooled effect, and its width is the 95% confidence interval of the pooled estimate. Interventions were associated with a 0.84% reduction in HbA1c; this decrease was statistically significant but very heterogeneous across studies (95.9% of heterogeneity was not explained by chance). HbA1c = hemoglobin A1c; RCT = randomized controlled trial; LEP = limited English proficiency; WMD = weighted mean difference.
Figure 3
Figure 3
Sensitivity analysis of the effect on HbA1c in studies with ≥50% of patients having limited English proficiency. HbA1c = hemoglobin A1c; LEP = limited English proficiency; WMD = weighted mean difference.
See this image and copyright information in PMC

Comment in

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