Background: Resource barriers complicate diabetes care management. Support from peers may help patients manage their diabetes.
Objective: To compare a reciprocal peer-support (RPS) program with nurse care management (NCM).
Design: Randomized, controlled trial. (ClinicalTrials.gov registration number: NCT00320112)
Setting: 2 U.S. Department of Veterans Affairs health care facilities.
Patients: 244 men with hemoglobin A1c (HbA1c) levels greater than 7.5% during the previous 6 months.
Measurements: The primary outcome was 6-month change in HbA1c level. Secondary outcomes were changes in insulin therapy; blood pressure; and patient reports of medication adherence, diabetes-related support, and emotional distress.
Intervention: Patients in the RPS group attended an initial group session to set diabetes-related behavioral goals, receive peer communication skills training, and be paired with another age-matched peer patient. Peers were encouraged to talk weekly using a telephone platform that recorded call occurrence and provided reminders to promote peer contact. These patients could also participate in optional group sessions at 1, 3, and 6 months. Patients in the NCM group attended a 1.5-hour educational session and were assigned to a nurse care manager.
Results: Of the 244 patients enrolled, 216 (89%) completed the HbA1c assessments and 231 (95%) completed the survey assessments at 6 months. Mean HbA1c level decreased from 8.02% to 7.73% (change, −0.29%) in the RPS group and increased from 7.93% to 8.22% (change, 0.29%) in the NCM group. The difference in HbA1c change between groups was 0.58% (P = 0.004). Among patients with a baseline HbA1c level greater than 8.0%, those in the RPS group had a mean decrease of 0.88%, compared with a 0.07% decrease among those in the NCM group (between-group difference, 0.81%; P < 0.001). Eight patients in the RPS group started insulin therapy, compared with 1 patient in the NCM group (P = 0.020). Groups did not differ in blood pressure, self-reported medication adherence, or diabetes-specific distress, but the RPS group reported improvement in diabetes social support.
Limitation: The study included only male veterans and lasted only 6 months.
Conclusion: Reciprocal peer support holds promise as a method for diabetes care management.
Primary Funding Source: U.S. Department of Veterans Affairs Health Services Research and Development Service.