Diabetes control is worse in children and young people with type 1 diabetes requiring interpreter support

Jan Idkowiak; Suma Uday; Sabba Elhag; Timothy Barrett; Renuka Dias; Melanie Kershaw; Zainaba Mohamed; Vrinda Saraff; Ruth E Krone

doi:10.3389/fcdhc.2023.1228820

Diabetes control is worse in children and young people with type 1 diabetes requiring interpreter support

Front Clin Diabetes Healthc. 2023 Nov 27:4:1228820. doi: 10.3389/fcdhc.2023.1228820. eCollection 2023.

Authors

Jan Idkowiak^#^{1

2

3}, Suma Uday^#^{1

2

3}, Sabba Elhag^{2

3}, Timothy Barrett^{2

3

4}, Renuka Dias^{1

2

3}, Melanie Kershaw^{2

3}, Zainaba Mohamed^{2

3}, Vrinda Saraff^{2

3}, Ruth E Krone^{2

3}

Affiliations

¹ Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
² Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham, Birmingham, United Kingdom.
³ Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom.
⁴ Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.

^# Contributed equally.

Abstract

Introduction: Language barriers can pose a significant hurdle to successfully educating children and young people with type 1 diabetes (CYPD) and their families, potentially influencing their glycaemic control.

Methods: Retrospective case-control study assessing HbA1c values at 0, 3, 6, 9, 12 and 18 months post-diagnosis in 41 CYPD requiring interpreter support (INT) and 100 age-, sex- and mode-of-therapy-matched CYPD not requiring interpreter support (CTR) in our multi-diverse tertiary diabetes centre. Data were captured between 2009-2016. English indices of deprivation for each cohort are reported based on the UK 2015 census data.

Results: The main languages spoken were Somali (27%), Urdu (19.5%), Romanian (17%) and Arabic (12%), but also Polish, Hindi, Tigrinya, Portuguese, Bengali and sign language. Overall deprivation was worse in the INT group according to the Index of Multiple Deprivation (IMD [median]: INT 1.642; CTR 3.741; p=0.001). The median HbA1c was higher at diagnosis in the CTR group (9.95% [85.2 mmol/mol] versus 9.0% [74.9 mmol/mol], p=0.046) but was higher in the INT group subsequently: the median HbA1c at 18 months post diagnosis was 8.3% (67.2 mmol/mol; INT) versus 7.9% (62.8 mmol/mol; CTR) (p=0.014). There was no hospitalisation secondary to diabetes-related complications in either cohorts.

Summary and conclusions: Glycaemic control is worse in CYPD with language barriers. These subset of patients also come from the most deprived areas which adds to the disadvantage. Health care providers should offer tailored support for CYP/families with language barriers, including provision of diabetes-specific training for interpreters, and explore additional factors contributing to poor glycaemic control. The findings of this study suggest that poor health outcomes in CYPD with language barriers is multifactorial and warrants a multi-dimensional management approach.

Keywords: communication barriers; diabetes outcome; hemoglobin A1c protein; language; social deprivation; type 1 diabetes.

Grants and funding

This work was supported by the Academy of Medical Sciences (Starter Grant for Clinical Lecturers SGL020/1013, to JI) and the National Institute of Health Research (NIHR) UK (Clinical Lectureship to JI). The views expressed in this publication are those of the author(s) and not necessarily those of the National Health Service, the National Institute for Health Research, or the Department of Health.