Michele Heisler, MD, MPA; Sandeep Vijan, MD, MS; Fatima Makki, MPH; John D. Piette, PhD
Resource barriers complicate diabetes care management. Support from peers may help patients manage their diabetes.
To compare a reciprocal peer-support (RPS) program with nurse care management (NCM).
Randomized, controlled trial. (ClinicalTrials.gov registration number: NCT00320112)
2 U.S. Department of Veterans Affairs health care facilities.
244 men with hemoglobin A1c (HbA1c) levels greater than 7.5% during the previous 6 months.
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.
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.
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.
The study included only male veterans and lasted only 6 months.
Reciprocal peer support holds promise as a method for diabetes care management.
U.S. Department of Veterans Affairs Health Services Research and Development Service.
Heisler M, Vijan S, Makki F, Piette JD. Diabetes Control With Reciprocal Peer Support Versus Nurse Care Management: A Randomized Trial. Ann Intern Med. ;153:507–515. doi: 10.7326/0003-4819-153-8-201010190-00007
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Published: Ann Intern Med. 2010;153(8):507-515.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism.
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