Language barrier and its relationship to diabetes and diabetic retinopathy

Background: Language barrier is an important determinant of health care access and health. We examined the associations of English proficiency with type-2 diabetes (T2DM) and diabetic retinopathy (DR) in Asian Indians living in Singapore, an urban city where English is the predominant language of communication. Methods. This was a population-based, cross-sectional study. T2DM was defined as HbA1c 6.5%, use of diabetic medication or a physician diagnosis of diabetes. Retinal photographs were graded for the severity of DR including vision-threatening DR (VTDR). Presenting visual impairment (VI) was defined as LogMAR visual acuity>0.30 in the better-seeing eye. English proficiency at the time of interview was assessed. Results: The analyses included 2,289 (72.1%) English-speaking and 885 (27.9%) Tamil- speaking Indians. Tamil-speaking Indians had significantly higher prevalence of T2DM (46.2 vs. 34.7%, p<0.001) and, among those with diabetes, higher prevalence of DR (36.0 vs. 30.6%, p<0.001), VTDR (11.0 vs. 6.5%, p