Capsule Commentary on Njeru et al., Diabetes Mellitus Management Among Patients with Limited English Proficiency: a Systematic Review and Meta-analysis Amy Cunningham, PhD, MPH Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA, USA. J Gen Intern Med 33(6):947 The findings from Njeru et al. suggest fruitful avenues for DOI: 10.1007/s11606-018-4422-x future research. Overall, the LEP population in the USA is © Society of General Internal Medicine 2018 very linguistically and culturally heterogeneous with substan- tial variations in country of origin, education level, and socio- economic status. Development and evaluation of DSME for specific LEP sub-populations would strengthen the evidence for DSME’s impact on LEP participants and clarify the most imited English proficiency (LEP) is associated with nu- effective intervention components for different groups. For merous health disparities, including poorer glycemic con- clinicians and health educators, understanding their local 1 2 trol in LEP patients with diabetes. In this issue, Njeru et al. LEP populations and working with community partners is report findings from a systematic review and meta-analysis critical to designing linguistically and culturally appropriate of diabetes self-management education (DSME) interven- DSME to meet the needs of this vulnerable population. tions in LEP populations. In their meta-analysis, DSME interventions were associated with a significant lower he- moglobin A (− 0.84% [95% CI, − 0.97 to − 0.71]) than 1c Corresponding Author: Amy Cunningham, PhD, MPH; Department usual care. Interventions lasting less than 6 months and of Family and Community Medicine Thomas Jefferson University, Philadelphia, PA, USA (e-mail: Amy.Cunningham@jefferson.edu). using in-person delivery were more likely to demonstrate improvements in hemoglobin A . Improvements in self- 1c Compliance with Ethical Standards: efficacy, quality of life, and several other measures were also reported. Conflict of Interest: The author declares that she does not have a This systematic review and meta-analysis is the first to conflict of interest. examine the impact of DSME in LEP populations, and in- cludes a sizable number of articles. The clinically significant reduction in hemoglobin A and positive effects on self- 1c REFERENCES efficacy and quality of life are encouraging findings that are 1. Choi S, Lee JA, Rush E. Ethnic and language disparities in diabetes care consistent with prior meta-analyses of DSME’seffect in the among California residents. Ethn Dis. 2011;21(2):183–9. 3 4 2. Njeru JW, Wieland ML, Kwete G, Tan EM, Breitkopf CR, general population and in racial and ethnic minority groups. Agunwamba AA, Prokop LJ, Murad MH. Diabetes mellitus manage- The study also has several notable limitations. Nearly half of ment among patients with limited english proficiency: a systematic review and meta-analysis. J Gen Intern Med. https://doi.org/10.1007/s11606- the included studies were non-randomized designs. Addition- 017-4237-1. ally, none of the interventions enrolled exclusively LEP par- 3. Steinsbekk A, Rygg L, Lisulo M, Rise MB, Fretheim A. Group based ticipants, and for nearly half of included studies, LEP partic- diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta- ipation rates were Binferred^ from demographics tables or the analysis. BMC Health Serv Res. 2012;12(1):213. article text. Furthermore, nearly all studies (94%) offered LEP 4. Ricci-Cabello I, Ruiz-Pérez I, Rojas-García A, Pastor G, Rodríguez- Barranco M, Gonçalves DC. Characteristics and effectiveness of diabetes accommodations, such as language-concordant staff or trans- self-management educational programs targeted to racial/ethnic minority lated materials, but it was unclear which accommodations groups: a systematic review, meta-analysis and meta-regression. BMC were most helpful to participants. Finally, the overall hetero- Endocr Disord. 2014;14(1):60. 5. Pandya C, Batalova J, McHugh M. Limited English proficient individuals geneity of the interventions, including delivery methods and in the United States: number, share, growth, and linguistic diversity intensity, precludes conclusions about the most effective [Internet]. Washington (DC): Migration Policy Institute; 2011 [cited 2017 Nov 28]. Available from: http://www.migrationinformation.org/integra- DSME designs for LEP populations. tion/LEPdatabrief.pdf. Published online April 9, 2018
Journal of General Internal Medicine – Springer Journals
Published: Apr 9, 2018
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