摘要：Objectives. We evaluated whether ethnicity and language are associated with diabetes care for Latinos in managed care. Methods. Using data from 4685 individuals in the Translating Research Into Action for Diabetes (TRIAD) Study, a multicenter study of diabetes care in managed care, we constructed multivariate regression models to compare health behaviors, processes of care, and intermediate outcomes for Whites and English- and Spanish-speaking Latinos. Results. Latinos had lower rates of self-monitoring of blood glucose and worse glycemic control than did Whites, higher rates of foot self-care and dilated-eye examinations, and comparable rates of other processes and intermediate outcomes of care. Conclusions. Although self-management and quality of care are comparable for Latinos and Whites with diabetes, important ethnic disparities persist in the managed care settings studied. Latinos are the most rapidly growing ethnic group in the United States 1 and have high rates of type 2 diabetes mellitus. 2 Among persons with diabetes, Latinos have more diabetic retinopathy and renal disease and higher age-adjusted death rates from diabetes than do Whites. 2– 5 These disparate outcomes by ethnicity are multifactorial, and a proportion of the observed differences may be attributable to poorer access to health care and the receipt of lower-quality care. 6 Some epidemiological studies suggest that health disparities for Latinos with diabetes can be attenuated in managed care settings, where racial and ethnic minorities may experience greater equality of access. 7, 8 However, few studies have evaluated racial/ethnic differences in individual health behaviors 9 or quality of care 7 among persons with diabetes in managed care settings, and very little of this work has focused on Latinos. Enrollment in managed care organizations may improve health care access for Latinos, but having health insurance does not completely eliminate barriers to care. 10 In managed care settings, Latinos may face obstacles associated with the administrative complexity of health plans, cultural differences between patients and health care professionals, and language barriers, placing them at increased risk for underuse of services, poor-quality care, and worse outcomes compared with Whites. 6, 11, 12 Prior research suggests that language barriers may be a particularly important influence on health behaviors among Latinos, 13 but the influence of language on diabetes-related health behaviors and quality of care remains poorly understood. Some studies have shown no decrement in quality of care for Latinos with limited English proficiency, 14, 15 although others have suggested that language barriers are associated with reduced rates of self-monitoring of blood glucose (SMBG). 16 We used data from the Translating Research Into Action for Diabetes (TRIAD) Study, a multicenter study of persons with diabetes in managed care, to evaluate differences in participation in diabetes-related self-care behaviors, processes of care, and intermediate outcomes of care among Whites, English-speaking Latinos, and Spanishspeaking Latinos with diabetes. We hypothesized that Latinos with diabetes would be at higher risk for poor health behaviors and quality of care because of educational obstacles and organizational and cultural barriers to receipt of care. We also anticipated that language barriers would place Spanish speakers at higher risk than English speakers for low participation in self-care behaviors and for poor processes and intermediate outcomes of care.
