(1062) Diabetes Distress Scores in English versus Non-english Speaking Type 2 Diabetes Patients

Objectives: Living with type 2 diabetes mellitus (T2DM), especially when uncontrolled, can be significantly burdensome and stressful to patients, affecting their social and emotional health. The Diabetes Distress Scale (DDS) is a 17-item self-reported survey that quantifies four different aspects of diabetes distress: emotional burden, and regimen-related, physician-related, interpersonal distress. Literature demonstrates that language barriers can have an impact on general health outcomes and satisfaction, however there is little to no research investigating effects on diabetes outcomes and distress. According to the 2018 Census Bureau report, 67.3 million United States citizens spoke a foreign language at home. A global systematic review identified several problems present within this patient population, including confusion regarding medication directions, and difficulty understanding medical situations, medical labels, and providers’ verbal instructions, increasing the potential for poor outcomes. The purpose of the research is to investigate the impact of being an English-speaker versus not being an English speaker on diabetes distress in a low-income T2DM population.

Methods: This single-center cross-sectional study will evaluate T2DM patients ≥18 years of age at Sinclair Health Clinic, a charitable clinic, who completed the DDS in 2023. All patients are < 300% federal poverty level, are Virginia residents, and are either uninsured or have Medicaid. Pregnant patients were excluded. Study investigators review the electronic health record (EHR) schedule to produce a list of T2DM patients. Following their diabetes management appointment with the primary care provider or pharmacist, patients are asked to sign a consent form prior to filling out the DDS survey, both in their preferred language. A medical interpreter is provided for non-English speakers. For illiterate patients, the investigator completes the survey verbally. The primary outcome is the percentage of English speakers versus non-English speakers who have a moderate total distress score or greater. Secondary outcomes include: percentage of each group with moderate distress or greater in each of the four subscales, percentage of those with moderate distress or greater with A1c < 7%, and percentage of males versus females with moderate distress or greater. Investigators review the EHR of qualified participants and collect demographic data, smoking status, past medical history, medications, lab values, vaccinations, vitals, insurance status, and foot and eye exam completion. Results will be analyzed using SPSS software.

Results: Preliminary results with a sample size of 19 demonstrate no statistically significant differences between English and non-English speakers for moderate or greater scores for total distress (50% vs. 38.5%, p=1.0), emotional burden (50% vs. 46.2%, p=1.0), regimen-related (66.7% vs. 53.8%, p=1.0), physician-related (0% vs. 23.1%, p=0.517), and interpersonal (33.3% vs. 30.8%, p=1.0) distress. At this time, one secondary outcome demonstrates statistical significance. Females had a higher percentage of moderate or greater scores regarding total distress (57.1% vs. 0%, p=0.045), emotional burden (64.3% vs. 0%, p=0.033), and regimen-related (78.6% vs. 0%, p=0.005) distress compared to males. There is currently no statistically significant difference between uninsured and Medicaid patients, patients with A1C ≤7% or >7%, and patients who are or are not prescribed insulin.

Conclusions: This study highlights the role language barriers can have on diabetes distress in T2DM patients and how health literacy can be a barrier for all patients. There may be clinical significance in distress burden between genders. We anticipate men may underreport scores due to societal narratives and that women may take on additional responsibilities in lower-income families. We anticipate a larger sample size may demonstrate statistically significant differences between other groups.