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Original Investigation
January 23, 2017

Association of Patient-Physician Language Concordance and Glycemic Control for Limited–English Proficiency Latinos With Type 2 Diabetes

Author Affiliations
  • 1Division of Research, Kaiser Permanente, Oakland, California
  • 2Division of General Internal Medicine, San Francisco General Hospital, San Francisco, California
  • 3Department of Medicine, University of California at San Francisco, San Francisco, California
  • 4Department of Adult and Family Medicine, Kaiser Permanente, Oakland Medical Center, Oakland, California
JAMA Intern Med. Published online January 23, 2017. doi:10.1001/jamainternmed.2016.8648
Key Points

Question  Does glycemic control improve for limited–English proficiency (LEP) Latinos with diabetes who switch from English-only to Spanish-speaking primary care physicians (PCPs)?

Findings  In this pre-post comparative study of 1605 LEP Latino patients with diabetes who switched PCPs, it was found that there was a significant 10% increase in the proportion of patients with glycemic control among those who switched from an English-only to a Spanish-speaking PCP compared with those who switched from one English-only PCP to another.

Meaning  Facilitating language-concordant care may be an effective strategy for diabetes management among LEP Latinos with diabetes.


Importance  Providing culturally competent care to the growing number of limited–English proficiency (LEP) Latinos with diabetes in the United States is challenging.

Objective  To evaluate changes in risk factor control among LEP Latinos with diabetes who switched from language-discordant (English-only) primary care physicians (PCPs) to language-concordant (Spanish-speaking) PCPs or vice versa.

Design, Setting, and Participants  This pre-post, difference-in-differences study selected 1605 adult patients with diabetes who self-identified as Latino, whose preferred language was Spanish, and who switched PCPs between January 1, 2007, and December 31, 2013. Study participants were members of the Kaiser Permanente Northern California health care system (an integrated health care delivery system with access to bilingual PCPs and/or professional interpreter services). Spanish-speaking and English-only PCPs were identified by self-report or utilization data.

Exposures  Change in patient-PCP language concordance after switching PCPs.

Main Outcomes and Measures  Glycemic control (glycated hemoglobin [HbA1c] < 8%), poor glycemic control (HbA1c > 9%), low-density-lipoprotein (LDL) control (LDL < 100 mg/dL), and systolic blood pressure (SBP) control (SBP < 140 mm Hg).

Results  Overall, 1605 LEP Latino adults with diabetes (mean [SD] age, 60.5 [13.1] years) were included in this study, and there was a significant net improvement in glycemic and LDL control among patients who switched from language-discordant PCPs to concordant PCPs relative to those who switched from one discordant PCP to another discordant PCP. After adjustment and accounting for secular trends, the prevalence of glycemic control increased by 10% (95% CI, 2% to 17%; P = .01), poor glycemic control decreased by 4% (95% CI, −10% to 2%; P = .16) and LDL control increased by 9% (95% CI, 1% to 17%; P = .03). No significant changes were observed in SBP control. Prevalence of LDL control increased 15% (95% CI, 7% to 24%; P < .001) among LEP Latinos who switched from concordant to discordant PCPs. Risk factor control did not worsen following a PCP switch in any group.

Conclusions and Relevance  We observed significant improvements in glycemic control among LEP Latino patients with diabetes who switched from language-discordant to concordant PCPs. Facilitating language-concordant care may be a strategy for diabetes management among LEP Latinos.