Diabetes Control With Reciprocal Peer Support Versus Nurse Care Management

Abstract

Background Many health care systems face barriers to implementing resource-intensive care management programs for patients with poorly controlled diabetes. Mobilizing patients to provide reciprocal peer support may enhance care management and improve clinical outcomes. Objective To compare the effectiveness of a reciprocal diabetes peer support program (RPS) with nurse care management (NCM) in improving glycemic control in real-world clinical settings. Design Six-month parallel randomized controlled effectiveness study from 2007–2010 (Trial Registration NCT00320112) Setting Two U.S. Veterans’Affairs (VA) health care facilities Participants 244 male diabetes patients with a hemoglobin A1c (HbA1c) in the prior 6 months of 7.5% or more. Primary Funding Source VA Health Services Research and Development (HSR&D) Measurements The primary outcome was change in HbA1c between baseline and six months. Secondary outcomes were new insulin starts and intensification, blood pressure, diabetes-specific social support, emotional distress, and medication adherence. Intervention Participants in both arms attended an initial session led by a nurse care manager to review and discuss their point-of-service HbA1c and blood pressure values, and most recent medical record cholesterol values. RPS patients then participated in a group session to set diabetes-related behavioral goals, receive brief training in peer communication skills, and be paired with another age-matched participant. Paired peer partners were encouraged to talk weekly using a telephone platform that recorded call frequency and duration and provided automated reminders promoting peer contact. Intervention participants were also offered three optional 1.5 hour patient-driven group sessions at months 1, 3, and 6 to share concerns, questions, strategies, and progress on goals. Patients in the NCM arm attended a 1.5 hour session to receive education on care manager services and diabetes educational materials and be assigned to a nurse care manager with whom they were encouraged to follow up regularly. Results Of the 244 patients enrolled, at six months 216 (89%) completed the HbA1c and 231 (95%) the survey assessments. RPS participants had a mean HbA1c of 8.02% at baseline, which improved to 7.73% at six months (−0.29%) compared with an average increase in HbA1c among NCM participants (7.93 to 8.22 [SD 0.29]). The difference between groups was 0.58% (p=0.004). Among patients with a baseline HbA1c >8.0%, RPS participants had a mean decrease of 0.88% compared with a 0.07% decrease among NCM participants (p<0.001). Eight RPS patients started insulin compared to one NCM patient (p=0.02), and RPS participants reported greater increases in diabetes social support than NCM participants (+11.4 vs. +4.5, p=0.01). There were no differences between groups at follow-up in blood pressure, self-reported medication adherence, or diabetes-specific distress. Limitations The study was limited to male veterans. It will be important to replicate this study in gender-mixed s...

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Society of Behavioral Medicine (SBM) position statement: SBM supports increased efforts to integrate community health workers into the patient-centered medical home

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