Study: Language barriers reduce CGM access for patients with type 2 diabetes

Author(s):

Austin Littrell

Fact checked by:

Keith A. Reynolds

Key Takeaways

Non-English language preference patients with type 2 diabetes are significantly less likely to receive CGM prescriptions, even when clinically indicated.
The study found a 42% lower likelihood of CGM prescriptions for NELP patients, despite adjustments for demographics and clinical factors.
Disparities in CGM access persist regardless of specific non-English languages spoken, indicating a broader language-related barrier.
The findings underscore the need to address language-related inequities in CGM access as availability increases.

Study finds patients with diabetes who prefer a non-English language are less likely to be prescribed continuous glucose monitors, even when their condition is poorly controlled.

Patients with type 2 diabetes who don’t speak English as their preferred language are significantly less likely to be prescribed a continuous glucose monitor (CGM), even when their health status calls for it, according to a new study published in JAMA Network Open.

Researchers reviewed records from nearly 70,000 adults receiving primary or endocrinology care between 2022 and 2023 in a large health system. Roughly 12% of those patients preferred a language other than English — most commonly Spanish. Only 7.4% of those patients received a CGM prescription, compared with 12.7% of English-speaking patients.

Even after adjusting for factors like age, gender, race, insurance, insulin use, diabetes severity and access to specialists, the gap held. Patients with non-English language preference (NELP) had 42% lower odds of receiving a CGM prescription.

The difference was even starker among patients who arguably need CGMs the most. For people with HbA1c levels higher than 9% — a key indicator of poor blood sugar control — CGM prescriptions were nearly 8 percentage points lower for patients with NELP than those who speak English. For patients on insulin, prescriptions were 7.6 points lower.

“We found disparities in CGM prescriptions by language preference, showing patients with NELP having less access to CGM,” the study’s authors wrote, led by Jorge A. Rodriguez, M.D., of Brigham and Women’s Hospital and Harvard Medical School.

No clear edge for Spanish speakers

Of the non-English speakers in the study, roughly 60% spoke Spanish. When comparing Spanish to non-Spanish speakers within that group, researchers found little difference in CGM access. After adjusting for clinical and demographic variables, the prescription rates were statistically similar. That is, it doesn’t seem to matter which language a patient speaks — if it’s not English, they’re at a disadvantage.

Beyond the numbers

The study couldn’t determine whether language-concordant care, or the use of interpreters, played a role in CGM prescribing. It also didn’t track whether patients who received prescriptions went on to actually use the devices.

Still, the findings add another layer to growing concerns about inequities in CGM access — extending beyond race and ethnicity, to language.

“As CGM availability increases, there is an urgent need to identify and reduce barriers to equitable CGM adoption among patients with NELP,” the authors concluded.