How Do Language Barriers Affect Diabetes Care for Patients With Limited English Proficiency?

By Jenny Esno, SVP, Commercial ·

Published November 10, 2026 · Updated November 10, 2026

Diabetes care depends on communication more than almost any other chronic condition. Patients have to understand dosing, recognize warning signs, adjust food and activity, and come back for regular checks. November is American Diabetes Month, and for health centers that serve large LEP populations, language access is part of the diabetes care plan.

How many health center patients with diabetes have limited English proficiency?

A large share of health center patients with diabetes are likely to have limited English proficiency, because both groups are large. In 2024, U.S. health centers served more than 8.9 million patients with limited English proficiency and more than 3.1 million patients with diabetes, according to federal Uniform Data System reporting.

According to HRSA Uniform Data System national data for 2024, 8,977,252 health center patients had limited English proficiency, which is 27.72% of patients with a known language. That share has risen every year since 2020, when it was 24.37%. The same 2024 data counts 3,114,413 health center patients with diabetes. For many health centers, diabetes care and language access are the same patient population.

Are patients with limited English proficiency less likely to reach A1c goals?

Yes. Patients with limited English proficiency are less likely to reach A1c goals than English-proficient patients, even at the same community health centers. A study of nearly 16,000 adults with type 2 diabetes at California health centers found LEP patients had lower odds of A1c control in both 2019 and 2020.

The study, by Ramos, Brown, and Rodriguez in the Journal of Primary Care & Community Health (January 2024), used EHR data from 15,965 adults at 88 California health center sites. LEP patients had about 15% lower odds of keeping A1c below 8% in 2019 (odds ratio 0.85) and about 17% lower odds in 2020 (odds ratio 0.83). Blood pressure screening and control were similar for LEP and English-proficient patients, which points to diabetes self-management, where communication carries the most weight, as a key gap.

How do language barriers affect access to diabetes technology?

Language barriers reduce access to diabetes technology. Patients who prefer a language other than English are less likely to be prescribed a continuous glucose monitor (CGM), even when their diabetes is harder to control. Newer tools often come with English-only apps, alerts, and training, which adds another barrier after the prescription.

A study of 69,269 adults with type 2 diabetes, by Rodriguez and colleagues in JAMA Network Open (June 17, 2025), found that 7.4% of patients who preferred a language other than English were prescribed a CGM, compared with 12.7% of English-preferring patients. The gap persisted among patients with A1c above 9% and among insulin users, the patients most likely to benefit. When a CGM is prescribed, training in the patient's language decides whether the device gets used.

Why do medication instructions matter so much in diabetes care?

Medication instructions matter in diabetes care because dosing errors with insulin and other glucose-lowering drugs can cause dangerous highs and lows. Patients with limited English proficiency need dosing, timing, and warning signs explained in their language, both during the visit and on the prescription label they take home.

Many patients never get translated written instructions. A survey of 169 prescribers at an academic medical center, by Manzor and colleagues in the Annals of Family Medicine (September 2026), found that 91.8% did not tell patients they could ask their pharmacy for a translated label, and 69.8% were not confident patients received accurate written instructions. A simple script at checkout ("You can ask your pharmacy for a label in your language") is an easy first fix.

Do interpreters and language-concordant care improve diabetes outcomes?

Evidence suggests language-concordant care improves diabetes outcomes. When LEP patients receive care in their own language, through a clinician who speaks it or a professional interpreter, they understand their treatment better and are more likely to reach blood sugar goals. Recent research on interpreter-supported diabetes care is still limited, so the strongest evidence remains somewhat dated.

The most cited study is published in 2017. Parker and colleagues in JAMA Internal Medicine (March 2017) followed 1,605 Latino adults with LEP at Kaiser Permanente who switched primary care physicians. After switching to a Spanish-speaking physician, the share of patients with A1c below 8% improved by 10% compared with patients who switched between physicians who did not speak Spanish. For health centers that cannot match every patient with a clinician who speaks their language, qualified interpreters at every diabetes visit are the practical path to the same goal.

Where do language barriers show up in the diabetes care journey?

Language barriers show up at every stage of the diabetes care journey: screening and diagnosis, medication starts and changes, self-management education, device training, refills, and follow-up outreach. Each stage needs a specific language access tool, from interpreters during visits to translated materials and reminders between them.

What goes wrong in diabetes care for patients with limited English proficiency?

The most common problem in diabetes care for patients with limited English proficiency is "getting by" without an interpreter in routine visits, when key teaching happens. Other frequent gaps include English-only education materials, machine-translated handouts with no human review, device training without an interpreter, and family members explaining insulin doses.

Each gap is small on its own, but diabetes care adds them up over years. Five patterns to look for in a health center's diabetes program:

1. Routine visits without an interpreter. Follow-up visits feel routine, but they are where dosing changes and self-management coaching happen.
2. English-only education. Diabetes self-management classes, handouts, and videos are available only in English.
3. Unreviewed translations. Patient materials are run through machine translation and handed out without review by a qualified human translator.
4. Device training in English. CGM and insulin pen training happens without an interpreter, so the device is never fully used.
5. Family members explaining doses. A relative relays insulin instructions, with no way to confirm accuracy.

How can health centers improve diabetes care for patients with limited English proficiency?

Health centers can improve diabetes care for patients with limited English proficiency by tracking diabetes measures by preferred language, using professional interpreters at every diabetes visit, translating core education materials with human review, offering device training with an interpreter, and telling patients they can request translated prescription labels.

Measuring by language is the first step, because a gap that is not tracked is easy to miss. A health center that stratifies its A1c control rates by preferred language can see whether LEP patients are falling behind and target its efforts. From there, building interpreter use into diabetes care team workflows, including diabetes educators, pharmacists, and community health workers, makes language access part of routine diabetes care instead of an extra step.

Frequently asked questions

Should diabetes self-management education be offered in other languages? Yes. Diabetes self-management education should be offered in the languages patients speak, either through in-language classes or with a professional interpreter. Education works only when patients can ask questions and practice skills. Handouts and videos used in the class should be translated by a qualified translator, not left to machine translation alone.

Can family members interpret insulin instructions for a patient? Family members should not be relied on to interpret insulin instructions. Insulin dosing errors can cause severe low or high blood sugar, and family members may skip details or translate terms incorrectly. A professional interpreter should be used for any visit that covers dosing, with teach-back to confirm the patient can explain the instructions back.

Are continuous glucose monitors available with non-English instructions? Some continuous glucose monitor apps and materials are available in languages other than English, but availability varies by device, app, and language. Health centers should check which languages each device supports before prescribing and provide device training with a professional interpreter so patients can set up the device and respond to alerts.

How can a health center tell if language barriers are affecting its diabetes outcomes? A health center can tell if language barriers are affecting diabetes outcomes by stratifying its diabetes quality measures, such as A1c control, by patients' preferred language. Comparing results for LEP and English-proficient patients shows whether a gap exists. Reviewing interpreter use during diabetes visits helps explain where the gap comes from.

Do pharmacies have to provide translated prescription labels? Requirements for translated prescription labels vary by state. Some states, such as New York and California, have laws or regulations requiring translated labels or interpretation at many pharmacies, while others have no specific rule. Patients can ask their pharmacy for a label in their language, and clinicians should let patients know that option exists.

See where language gaps affect your diabetes program

GLOBO can help your team review interpreter use across diabetes visits and identify the patient materials that need translation first. Talk with our language access team.

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