Glycemic Control in English- vs Spanish-Speaking Hispanic Patients With Type 2 Diabetes Mellitus

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Abstract
THE ROLE that English fluency and proficiency play in the health care of Hispanic patients with diabetes mellitus in the United States is not completely understood. Language barriers to care may have important health and medical economic implications since Hispanic individuals compose the fastest growing minority group in the United States,1 and Hispanic individuals have higher rates of mortality due to diabetes mellitus and complications, such as peripheral vascular disease, amputations, and end-stage renal disease, than whites.2-4 Spanish-speaking (SS) adults are more likely to be older, to live in urban areas, to be less well educated, to be unemployed, to lack medical insurance, to report poorer health status, and to score lower on measures of self-determination than English-speaking (ES) adults.5,6Self-determination is a construct that refers to individuals' perception of the degree to which their behavior is responsible for their health. Schur et al5,6 measured self-determination using several health belief statements rated by patients according to how strongly they agreed or disagreed with each. For example, SS patients were more likely than ES patients to attribute a large role in the recovery from an illness to luck. Studies7,8 have shown that SS Hispanic patients are less likely than ES Hispanic patients to have a regular source of medical care, to undergo screening, to use preventive services, and/or to be referred to a specialist. In other studies,5,9 SS was not significantly associated with limited access to health care services after controlling for socioeconomic and cultural factors known to decrease use of health care services. Language acculturation that is, learning to speak English, among Hispanic individuals has been found to predict use of preventive screening in some studies.10,11 Although the negative impact of the inability to speak English fluently on access to health care has been fairly well characterized, its impact on other aspects of health care has received less scrutiny.