No abstract

PURPOSE Peer support intervention trials have shown varying effects on glycemic control. We aimed to estimate the effect of peer support interventions delivered by people affected by diabetes (those with the disease or a caregiver) on hemoglobin A 1c (HbA 1c ) levels in adults. METHODSWe searched multiple databases from 1960 to November 2015, including Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, CINAHL, and Scopus. We included randomized controlled trials (RCTs) of adults with diabetes receiving peer support interventions compared with otherwise similar care. Seventeen of 205 retrieved studies were eligible for inclusion. Quality was assessed with the Cochrane risk of bias tool. We calculated the standardized mean difference (SMD) of change in HbA 1c level from baseline between groups using a random effects model. Subgroup analyses were predefined.RESULTS Seventeen studies (3 cluster RCTs, 14 RCTs) with 4,715 participants showed an improvement in pooled HbA 1c level with an SMD of 0.121 (95% CI, 0.026-0.217; P = .01; I 2 = 60.66%) in the peer support intervention group compared with the control group; this difference translated to an improvement in HbA 1c level of 0.24% (95% CI, 0.05%-0.43%). Peer support interventions showed an HbA 1c improvement of 0.48% (95% CI, 0.25%-0.70%; P <.001; I 2 = 17.12%) in the subset of studies with predominantly Hispanic participants and 0.53% (95% CI, 0.32%-0.73%; P <.001; I 2 = 9.24%) in the subset of studies with predominantly minority participants; both were clinically relevant. In sensitivity analysis excluding cluster RCTs, the overall effect size changed little. CONCLUSIONSPeer support interventions for diabetes overall achieved a statistically significant but minor improvement in HbA 1c levels. These interventions may, however, be particularly effective in improving glycemic control for people from minority groups, especially those of Hispanic ethnicity. Ann Fam Med 2016;14:540-551. doi: 10.1370/afm.1982. INTRODUCTIONT he global burden of diabetes is expected to increase from 381.8 million people affected in 2013 to an estimated 591.9 million by 2035.1 Despite increasing evidence of benefits from self-management education, only 5% of Medicare-insured and 7% of privately insured people with diabetes receive this intervention within 1 year of diagnosis. [2][3][4] Diabetes self-management education improves hemoglobin A 1c (HbA 1c ) levels, and longer duration of education further lowers levels; however, the benefits decline 1 to 3 months after education ends. 5 The World Health Organization (WHO) has stated that peer support appears to be a promising approach to improving and sustaining diabetes self-management behaviors. 6 Randomized controlled trials (RCTs) using peer support interventions delivered by people affected by diabetes have shown varying results on glycemic control, however. A 2012 narrative review examined the effect of peer support interventions on diabetes outcomes, but several additional studies with these interventions have b...

BackgroundPeer support by persons affected with diabetes improves peer supporter’s diabetes self-management skills. Peer support interventions by individuals who have diabetes or are affected by diabetes have been shown to improve glycemic control; however, its effects on other cardiovascular disease risk factors in adults with diabetes are unknown. We aimed to estimate the effect of peer support interventions on cardiovascular disease risk factors other than glycemic control in adults with diabetes.MethodsWe conducted a systematic review and meta-analysis of randomized controlled trials comparing peer support interventions to a control condition in adults affected by diabetes that measured any cardiovascular disease risk factors [Body Mass Index, smoking, diet, physical activity, cholesterol level, glucose control and blood pressure]. Quality was assessed by Cochrane’s risk of bias tool. We calculated standardized mean difference effect sizes using random effects models.ResultsWe retrieved 438 citations from multiple databases including OVID MEDLINE, Cochrane database and Scopus, and author searches. Of 233 abstracts reviewed, 16 articles met inclusion criteria. A random effects model in a total of 3243 participants showed a positive effect of peer support interventions on systolic BP with a pooled effect size of 2.07 mmHg (CI 0.35 mmHg to 3.79 mmHg, p = 0.02); baseline pooled systolic blood pressure was 137 mmHg. There was a non-significant effect of peer support interventions on diastolic blood pressure, cholesterol, body mass index, diet and physical activity. Cardiovascular disease risk factors other than glycemic control outcomes were secondary outcomes in most studies and baseline values were normal or mildly elevated. Only one study reported smoking outcomes.ConclusionsWe found a small (2 mmHg) positive effect of peer support interventions on systolic blood pressure in adults with diabetes whose baseline blood pressure was on average minimally elevated. Additional studies need to be conducted to further understand the effect of peer support interventions on high-risk cardiovascular disease risk factors in adults with diabetes.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5326-8) contains supplementary material, which is available to authorized users.

Geographic information systems are powerful tools for combining disparate data in a visual format to illustrate complex relationships that affect health care access. These systems can help evaluate interventions, inform health services research, and guide health care policy. Arch Fam Med. 2000;9:971-978

No abstract