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, Mohammad H Murad

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalJournal of General Internal Medicine
DOIs
StateAccepted/In press - Dec 18 2017

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Type 2 Diabetes Mellitus
Meta-Analysis
Diabetes Mellitus
Randomized Controlled Trials
Self Efficacy
Diabetes Complications
North America
LDL Cholesterol
Observational Studies
Hemoglobins
Quality of Life
Blood Pressure
Health
Research
Population
Non-Randomized Controlled Trials

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Diabetes Mellitus Management Among Patients with Limited English Proficiency : A Systematic Review and Meta-Analysis. / Njeru, Jane W.; Wieland, Mark L.; Kwete, Gracia; Tan, Eugene M.; Radecki Breitkopf, Carmen; Agunwamba, Amenah A.; Prokop, Larry J.; Murad, Mohammad H.

In: Journal of General Internal Medicine, 18.12.2017, p. 1-9.

Research output: Contribution to journalArticle

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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.",
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AU - Njeru, Jane W.

AU - Wieland, Mark L.

AU - Kwete, Gracia

AU - Tan, Eugene M.

AU - Radecki Breitkopf, Carmen

AU - Agunwamba, Amenah A.

AU - Prokop, Larry J.

AU - Murad, Mohammad H

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AB - 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.

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