Type 2 Diabetes

Did you know non-English language preference (NELP) patients with type 2 diabetes (T2D) are less likely to get continuous glucose monitor (CGM) prescriptions? Yep, even when receiving care at the same clinics as English-speaking patients. That’s not me being dramatic—it’s straight from a study in JAMA Network Open from June 2025. They looked at over 8,000 patients, and the gap was obvious: if your preferred language wasn’t English, access to real-time diabetes care tools dropped. Think about it: if a tool like a CGM helps you track blood sugar without poking fingers and gives alerts for highs and lows… shouldn’t everyone who needs it get it? Like, that’s kind of the point, right? But reality? Let me show you what’s going on, why it’s everyone’s problem, and honestly? How we fix this stuff together. Language Shapes Who Gets a CGM—And Who Doesn’t You’re at the doctor’s office. You’ve done all your homework. You mention you’re struggling with blood sugar swings overnight, and your doctor waves off the idea of a CGM. Why? Sometimes, it’s not about your health stats—it’s about the language you’re comfortable in. Crazy? Let’s break this down. What Do the Numbers Actually Say? A study reviewed 8,460 patients with T2D. Results? About 12.2% of English-speaking patients got CGM prescriptions… versus a much smaller share for folks who preferred Spanish, Mandarin, Vietnamese, or other languages. And get this: this wasn’t about income, insurance, or how bad their diabetes was. The disconnect was purely between language and access. Whether you’re reading this in English or not—this matters. Because CGMs aren’t fancy gadgets. They’re game-changers. If you’re missing them, you’re flying blind in a world where a few missteps can land you with kidney issues or worse. Why Are NELP Patients Left Behind? Medical teams often assume NELP patients won’t “handle” CGMs because tech manuals or alerts are in English. But here’s the thing: technology isn’t the problem—systemic biases in healthcare are. Doctors might think, “They might not understand the data,” so they default to older methods like finger sticks. And boom: disparities get baked in. Another angle? Many clinics just don’t have translated resources. Think Dx apps, training guides, even support hotlines. Now imagine that as someone who navigates life in a language your doctor doesn’t share. Yeah… it’s not minor. The Bigger Question: Is This a Communication Gap? The Freestyle Libre website confirms this: their CGM systems require a prescription. But what if you can’t get that because of how you speak? Or worse, what if you don’t even know it exists as an option? That’s not just a problem—it’s a crisis of information. Here’s the kicker: even families who speak English at home might not feel confident enough to ask about advanced tools. For example, a patient who’s used to relying on family for translations might skip asking about CGMs, assuming the device is “too hard.” Nothing could be further from the truth. ELP Patients (English Language Preference) NELP Patients (Non-English Language Preference) 12.2% received CGM prescriptions Significantly lower rates, though exact percentage varies Likely to seek CGM options actively Oftentimes unaware of eligibility or how to ask Why CGMs Are Not Just “Nice To Have” for T2D You’ve probably heard about CGMs for type 1 diabetes. But did you know they’re a total game-changer for T2D too? These devices reduce finger-prick tests, alert you to sugar spikes/lows you might miss, and help adjust medications or insulin already in your system. Let’s be real: when your body’s not using insulin right, why leave the rest to guesswork? CGM Pros: Speed, Safety, & Smarter Choices Real-time data, not dated finger-prick numbers. Connected apps that share results with caregivers. (How cool is that?) No more surprises: alerts when glucose drops to dangerous levels while sleeping. A recent case in a Chicago clinic made headlines. Maria, a T2D patient who spoke mostly Spanish, finally got a Dexcom CGM after switching to a bilingual provider. Within weeks, her A1c improved. She discovered how blood sugar dipped after her morning mate or spiked post-taco dinner. “I thought my sugars were stable,” she said. “Turns out, I was wrong.” That’s what CGMs give you: a clear, unfiltered view of your body’s glucose dance. When CGMs Aren’t an Option, the Fallout Is Real If you’re not on a CGM—and your diabetes is complex—it’s like driving at night with no headlights. Yeah, you can technically do it, but the risks? Way higher. Without access to real-time alerts, NELP patients might miss hypoglycemic episodes altogether. Imagine jolting awake with a bad headache… only to find out your glucose dropped to 50 mg/dL. That’s not fun. It’s also avoidable with a CGM, but if you’re not even offered one? It’s a lose-lose. The Barriers We Don’t Always Talk About You and I both know, CGMs aren’t perfect. There’s stuff like alerts that blare at midnight, sticky sensors, and the occasional weird false reading. I’ve been there—reminding my buddy Jija about her CGM going haywire after a marathon Netflix binge. “It said I was diabetic panda… what the??” Well, maybe it was 16 mg/dL instead of “panda”… but still, right? But here’s where language preference diabetes disparities twist the knife: these challenges are harder to navigate if functional English isn’t your thing. Let’s explore that friction. Alarm Fatigue & Language: A Quiet Storm The phenomenon of alarm fatigue (when users grow numb to alerts) is a valid concern. But for NELP patients, it can be compounded by unclear notifications. Picture your sensor chirping, and the screen flashes, “Glucose Level Below Target.” Said in English that’s fine. But if you’re used to commands like “Bajo nivel de glucosa,” misinterpreted warnings could mean skipped action—or DKA in extreme cases. Physical Issues: Skin Reactions You Can’t Brush Off Some patients stop using CGMs because of skin issues like allergies or irritation. Again, fair reason, but harder to address when communication’s not crystal. What happens if you’re Hindi-speaking and your clinic’s materials are only in English? You might not know calamine works. Or if a sensor placement technique is wrong. That’s when discomfort turns into dropout. Lost in Translation: Real Recipe for Risk The real messy part? Miscommunication slows tech adoption for patients who could benefit most. For example, a study pointed out that even when eligible, NELP patients fear their provider will judge them if they hesitate to go tech-first. That’s soul-crushing to hear. CGM use should be a choice, not a filter built on language or assumptions. We can—and must—do better. Fixing the Access Gap: From Zoom Rooms to App-licious Tech So how do we close this gap? It’s not curtains. There are ways to make diabetes care access equitable—starting with clinics stepping into language-inclusive care. Strategies for Healthcare Teams: A Blueprint Hire bilingual diabetes educators. Can’t swing that? Virtual interpreters (through platforms like Zoom) or medical tags for non-English speakers can help. Train providers to avoid language-based stereotypes. Assume ability, not confusion. Guide patients with, “Hey, here’s how it works—want to try?” Offer translated materials. Yep, Dexcom and FreeStyle have steps-by-step CGM guides, but not everyone has dual-language ones yet. Clinicians are learning, too. A recent article in MedicalX Press showed how doctors prescribe fewer devices when they assume patients won’t use them correctly. That bias? It kills access. How Can Patients Be Their Own Advocate? Easy? No. Necessary? Oh yeah. If you need help with diabetes care access, start asking direct questions. Like: “Is the CGM training available in Spanish/Tagalog/Cantonese?” “What are common errors to watch for?” “Can I demo the device before committing?” Trust me, your provider will appreciate your interest. If in-person conversations aren’t your thing? Use their patient portal. Written documentation gives you time to process things and never leaves you guessing. How to Use Tech Without Language Getting in the Way If you’re swimming in CGM options but need help understanding their nuances, consider trusted online communities. Apps like MySugr or devices like Dexcom have forums where patients of diverse backgrounds share hacks. A mom in Toronto told me, “I only tried CGM because a fellow Punjabi sister reviewed it on YouTube. Her English broke halfway, but it was enough. We both got lucky.” That’s the power of relatable support. How Do You Know if a CGM Is Right for You? You’ve heard the numbers, seen Maria’s story. But maybe you’re wondering, “Wait, is a CGM for me in the first place?” Well, here are the basics. CGMs usually require a prescription, which can be a barrier if you’re not getting offered one. They work best if you’re willing to wear a tiny sensor on your arm or stomach for a week. If you’re okay with alerts, adjustments, and using an app, the rewards outweigh the hassle for most. Clinical guidelines from ADCES advise: CGMs shouldn’t be forced on unwilling patients. But the flip side? They shouldn’t be withheld from willing ones either—no matter how you speak, what page in English you’re on, or if your vocabulary spills into Google Translate gnarly translations. Moving Forward: Rewriting the Rx Norm If you’ve made it this far, first: thank you!! You’re clearly serious about diabetes care access. Second? Breathe. This isn’t one of those, “You’re doomed to deal with this.” We’re getting somewhere. From clinics offering Spanish-speaking training to patient advocates creating translated CGM manuals, the shift’s starting. We just need to push harder. Because disparities in diabetes management don’t just harm the individual—they ripple out. What keeps you up at night about your diabetes? Could a CGM help you sleep better? Or maybe there’s a NELP solution near you—try asking a fellow patient. Drop a line in the comments or reach out. Let’s build a tribe of people sharing the straight-up truth, not just the official guidelines. We’ve talked CGM prescriptions, T2D disparities, language preference diabetes challenges, and the reliability of this tech. If you’ve been caught in the loop, take heart. The path to better diabetes tools isn’t as technical as they say—it’s cultural, too. And culture changes when we push on it. Frequently Asked Questions What is a continuous glucose monitor, and who benefits from it? A continuous glucose monitor tracks blood sugar levels in real time, helpful for people with type 2 diabetes managing unpredictable glucose swings or requiring frequent adjustments. Why do language preferences affect CGM prescription rates? Providers may underestimate non-English-speaking patients’ ability to use CGMs due to assumptions about tech comprehension, limited translated resources, and systemic communication gaps in care teams. Can non-English speakers use CGM devices effectively? Absolutely—if given proper training, culturally relevant materials, and access to bilingual providers. Studies show success rates equal those of English speakers once barriers are addressed. What alternatives exist for patients missing out on CGMs? Traditional finger-stick monitors remain common, but advocacy groups encourage clinics to offer virtual demos, translated education, and peer support to help patients explore tools like CGMs confidently. How can patients advocate for CGM access without English fluency? Bring a trusted interpreter, request device demos in your language, and use patient portals for written communication to clarify doubts about continuous glucose monitor use and coverage.