Effectiveness of peer support for improving glycaemic control in patients with type 2 diabetes: a meta-analysis of randomized controlled trials

Li, Qi; Q, Liu; Qi, Xiaoling; Wu, Na; Tang, Wenge; Xiong, Hongyan

doi:10.1186/s12889-015-1798-y

Cited by 114 publications

(121 citation statements)

References 46 publications

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“…A recent meta-analysis showed that peer support delivered through telephone calls were just as effective as in-person contacts for patients with diabetes. 23 This is particularly important because these authors also found that greater frequency of contact with peers was a critical factor for successful outcomes. Telephone-delivered support is a relatively low-cost, readily available means to facilitate contact frequency between patients and peer coaches.…”

Section: Discussionmentioning

confidence: 99%

Facilitators and Barriers to Participation in a Peer Support Intervention for Veterans With Chronic Pain

Matthias

Kukla

McGuire

et al. 2016

The Clinical Journal of Pain

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Objective To understand facilitators and barriers to participation in a peer support intervention for self-management of chronic pain. Methods After completing a pilot intervention study, peer coaches and their Veteran patients took part in a qualitative, semi-structured interview to explore their experiences with the intervention. Data were analyzed using an immersion/crystallization approach. Results Three facilitators and two barriers to patient participation in a peer support intervention for veterans with chronic pain emerged. Facilitators were 1) having a shared identity as veterans, 2) being partnered with a person who also has chronic pain, and 3) support from the study staff. Barriers were 1) logistical challenges, and 2) challenges to motivation and engagement in the intervention. Discussion Awareness of facilitators and barriers to participation in a peer supported self-management program for chronic pain, as well as strategies to capitalize on facilitators and mitigate barriers, are essential for further study and ultimate clinical implementation of such a program.

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Section: Discussionmentioning

confidence: 99%

Facilitators and Barriers to Participation in a Peer Support Intervention for Veterans With Chronic Pain

Matthias

Kukla

McGuire

et al. 2016

The Clinical Journal of Pain

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“…Peer support can be defined as support from persons who have the same health condition as the people they assist and who experience similar challenges of those with the condition [10–12]. The use of lay mentors or community health care workers to support a lifestyle intervention, and reduce the very high costs of more intensive research interventions was recognized by the early triallists [3].…”

Section: Discussionmentioning

confidence: 99%

“…The costs of diabetes prevention intervention can be reduced by group based delivery [6] and the team who delivered the landmark study in this area recognised that ‘community health workers’ could be an attractive model for delivering lifestyle intervention at reduced cost [6]. There has been growing interest in this model over the last few years for the clinical management of Type 2 diabetes, and to a lesser degree in diabetes prevention [10–12]. Recent changes in the diagnostic criteria for diabetes, with a shift from glucose based criteria to one based on HbA1c, with a diagnostic threshold of an HbA1c ≥48 mmol/mol is widely supported and adopted [13, 14].…”

Section: Background and Rationalementioning

confidence: 99%

Study Protocol: The Norfolk Diabetes Prevention Study [NDPS]: a 46 month multi - centre, randomised, controlled parallel group trial of a lifestyle intervention [with or without additional support from lay lifestyle mentors with Type 2 diabetes] to prevent transition to Type 2 diabetes in high risk groups with non - diabetic hyperglycaemia, or impaired fasting glucose

et al. 2017

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BackgroundThis 7 year NIHR programme [2011–2018] tests the primary hypothesis that the NDPS diet and physical activity intervention will reduce the risk of transition to type 2 diabetes (T2DM) in groups at high risk of Type 2 diabetes. The NDPS programme recognizes the need to reduce intervention costs through group delivery and the use of lay mentors with T2DM, the realities of normal primary care, and the complexity of the current glycaemic categorisation of T2DM risk.MethodsNDPS identifies people at highest risk of T2DM on the databases of 135 general practices in the East of England for further screening with ab fasting plasma glucose and glycosylated haemoglobin [HbA1c]. Those with an elevated fasting plasma glucose [impaired fasting glucose or IFG] with or without an elevated HbA1c [non -diabetic hyperglycaemia; NDH] are randomised into three treatment arms: a control arm receiving no trial intervention, an arm receiving an intensive bespoke group-based diet and physical activity intervention, and an arm receiving the same intervention with enhanced support from people with T2DM trained as diabetes prevention mentors [DPM]. The primary end point is cumulative transition rates to T2DM between the two intervention groups, and between each intervention group and the control group at 46 months. Participants with screen detected T2DM are randomized into an equivalent prospective controlled trial with the same intervention and control arms with glycaemic control [HbA1c] at 46 months as the primary end point. Participants with NDH and a normal fasting plasma glucose are randomised into an equivalent prospective controlled intervention trial with follow up for 40 months. The intervention comprises six education sessions for the first 12 weeks and then up to 15 maintenance sessions until intervention end, all delivered in groups, with additional support from a DPM in one treatment arm.DiscussionThe NDPS programme reports in 2018 and will provide trial outcome data for a group delivered diabetes prevention intervention, supported by lay mentors with T2DM, with intervention in multiple at risk glycaemic categories, and that takes into account the realities of normal clinical practice.Trial registration ISRCTN34805606 (Retrospectively registered 16.3.16)Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3929-5) contains supplementary material, which is available to authorized users.

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“…7 One recent meta-analysis looked at peer support for improv-ing glycemic control, yet this analysis included trials with community health workers and bilingual clinic employees as peer health coaches and was missing a few intervention trials that used people affected by diabetes as peer supporters. 8 Hence, to date, there has not been an adequate systematic review and meta-analysis of the overall effectiveness of peer support interventions delivered by people affected by diabetes to inform policy or potential health care delivery changes.…”

Section: Introductionmentioning

confidence: 99%

Peer Support Interventions for Adults With Diabetes: A Meta-Analysis of Hemoglobin A1c Outcomes

Patil

Ruppar

Koopman

et al. 2016

The Annals of Family Medicine

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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...

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Effectiveness of peer support for improving glycaemic control in patients with type 2 diabetes: a meta-analysis of randomized controlled trials

Abstract: Background: To assess the effects of peer support at improving glycemic control in patients with type 2 diabetes.

Cited by 114 publications

References 46 publications

Facilitators and Barriers to Participation in a Peer Support Intervention for Veterans With Chronic Pain

Facilitators and Barriers to Participation in a Peer Support Intervention for Veterans With Chronic Pain

Peer Support Interventions for Adults With Diabetes: A Meta-Analysis of Hemoglobin A1c Outcomes

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