The impact of not speaking English as a first language on diabetes control and outcomes in primary care

Date of ISAC Approval: 
Lay Summary: 
Previous studies which investigated the impact of not speaking the same language as your doctor on different aspects of people's health have shown mixed results. This study will look at patients with type 2 diabetes in the UK. It will compare those whose first language is English with those whose first language is not English or who require an interpreter, according to their GP records. We will presume the second group do not speak the same language as their doctor or nurse. The aim of the study is to determine whether these patients are more likely to have poorly controlled diabetes or have a higher chance of developing more severe diabetes or complications from their illness. The outcomes that we will look at are how well a patient's sugar levels and blood pressure are controlled, the rate that they develop complications from their diabetes at and whether they go on to require insulin to treat their type 2 diabetes (a marker of more severe diabetes). If patients not speaking English as their first language do have differences compared to this those speaking English as a first language this may help target interventions to improve this difference.
Technical Summary: 
The aim of this study is to investigate the effect of not speaking English as a first language on control of, and outcomes from, type 2 diabetes (T2DM) in primary care. It could be postulated that not speaking English as a first language will affect many aspects of a patient's care, though no previous population-level studies have investigated this hypothesis in the UK. We will use a cohort study design of patients with newly diagnosed T2DM to investigate differences in markers of disease control, time to development of more severe T2DM, as shown by initiation of insulin and rates of developing complications from diabetes (controlling for baseline disease status). The specific outcomes will be HbA1c, blood pressure, and the development of microvascular (diabetic eye disease, nephropathy and neuropathy) and macrovascular complications (peripheral vascular disease, cardiovascular disease or stroke/TIA), and a new insulin requirement. Outcomes will be analysed by linear and logistic regression (for HbA1c and blood pressure) and cox proportional hazards regression (for rates of developing complications and initiation of insulin), controlling for potential confounders. If patients who don't speak English as a first language are shown to have differing outcomes then further research could be aimed at investigating the cause, and targeting interventions to address, this difference.
Health Outcomes to be Measured: 
- Haemoglobin A1c (HbA1C) - Macrovascular complications of diabetes - Systolic blood pressure - Prescription of insulin - microvascular complications of diabetes

Dr Florence Wedmore - Chief Investigator - London School of Hygiene & Tropical Medicine (LSHTM)
Dr Florence Wedmore - Corresponding Applicant - London School of Hygiene & Tropical Medicine (LSHTM)
Dr Rohini Mathur - Collaborator - London School of Hygiene & Tropical Medicine (LSHTM)

Patient IMD;Practice IMD (Standard)