1408-P: Use of Antihyperglycemic Medications among U.S. Patients with Limited English Proficiency

Language-concordant care enhances self-management and adherence of patients. In agreement, limited English proficiency (LEP) is adversely associated with glycemic control and cardiovascular health of patients with diabetes mellites (DM). New antihyperglycemic medications with high effectiveness and cardiovascular benefit are now available in the market. The STEPS analysis identifies simplicity of administration as an important parameter for assessing medications, and communication barriers can complicate prescribing decisions for patients with LEP. This study examines the pharmacologic management of DM by LEP status. Data are for non-pregnant adults recruited for the National Health and Nutrition Examination Survey (NHANES, 2003-18). The sample included 4645 participants with self-reported physician-diagnosed probable type 2 DM (age of diagnosis ≥ 20 years; not solely using insulin). Most participants completed the NHANES interview in English (90%), whereas 7% completed the interview in Spanish and 3% requested an interpreter. Approximately 20% of English-speaking, 27% of LEP-Spanish, and 15% of LEP-interpreter participants did not use any antihyperglycemic medication in the past 30 days (Rao-Scott χ2 p = 0.003). The use of medications with hypoglycemia risk (insulin and/or secretagogues) did not differ by LEP status (52%, 52%, and 57%; p = 0.6). Similarly, there were no differences in the use of metformin (69%, 73%, and 64%; p = 0.3) or newer medications (GLP1 agonists, SGLT2 and DPP4 inhibitors) with weight loss or cardiovascular benefits (12%, 10%, and 11%; p = 0.7) between the 3 groups. Medications with cardiovascular risk (thiazolidinediones) were more commonly used among English-speaking (14%) than LEP-Spanish (7%) and LEP-interpreter participants (12%; p = 0.04). Pharmacologic management of DM did not significantly differ based on LEP status, suggesting that access to effective antihyperglycemic medications does not explain the observed disparities in DM control.