Effectiveness of Technologically Enhanced Peer Support in Improving Glycemic Management Among Predominantly African American, Low-Income Adults With Diabetes

Heisler, Michele; Choi, Hwajung; Mase, Rebecca; Long, Judith A.; Reeves, Pamela

doi:10.1177/0145721719844547

Cited by 33 publications

(30 citation statements)

References 40 publications

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“…In such an analysis, a conceptual model is created that hypothesizes potential targets, or mediators, along the mechanistic pathway that an intervention must include in order to be successful in achieving the desired outcome. In the previously mentioned RCT by Heisler et al [ 23 ], participants had at least weekly contact with a fellow patient with T2D who had received a 2-hour training session with a focus on motivational interviewing, including active listening skills, rolling with resistance, enhancing change talk, goal setting, and action planning. During these sessions, peer coaches helped participants develop and follow up on weekly action steps to meet the participants’ defined behavioral goals.…”

Section: Methodsmentioning

confidence: 99%

“…Peer support interventions have been successful in improving both glycemic outcomes and psychosocial outcomes, including diabetes distress, and are an attractive, low-cost approach for health care systems [ 20 - 22 ]. A recently published randomized controlled trial (RCT) of peer support versus technology-enhanced peer support for primarily African American veterans with T2D who receive care at an urban Veterans Affairs (VA) health center published by Heisler et al [ 23 ] demonstrated that the peer coach model they evaluated, both with and without technology enhancement, was effective at improving glycemic control and reducing diabetes distress over the 6-month intervention period.…”

Section: Introductionmentioning

confidence: 99%

“…In this trial, participants were randomized to peer coaches without any additional eHealth tools or to peer coaches using an individually tailored, web-based educational tool (iDecide) over the course of 6 months. This tool had interactive features to allow participants to understand their personal diabetes risk profile as well as explore options for medications based on cost, effectiveness, and side effects [ 23 ]. Peer coaches all received training in motivational interviewing [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

“…This tool had interactive features to allow participants to understand their personal diabetes risk profile as well as explore options for medications based on cost, effectiveness, and side effects [ 23 ]. Peer coaches all received training in motivational interviewing [ 23 ]. In this trial, both arms achieved statistically and clinically significant improvements in both diabetes distress and HbA 1c without any significant difference between the two intervention arms [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

“…Peer coaches all received training in motivational interviewing [ 23 ]. In this trial, both arms achieved statistically and clinically significant improvements in both diabetes distress and HbA 1c without any significant difference between the two intervention arms [ 23 ]. This successful trial thus presents an opportunity to explore the psychosocial mechanisms that lead to improvements in glycemic control when diabetes distress is reduced as well as the participant baseline characteristics that may predict responsiveness to such an intervention.…”

Section: Introductionmentioning

confidence: 99%

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Diabetes Distress and Glycemic Control in Type 2 Diabetes: Mediator and Moderator Analysis of a Peer Support Intervention

Mizokami-Stout¹,

Choi²,

Richardson³

et al. 2021

JMIR Diabetes

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Background High levels of psychosocial distress are correlated with worse glycemic control as measured by glycosylated hemoglobin levels (HbA1c). Some interventions specifically targeting diabetes distress have been shown to lead to lower HbA1c values, but the underlying mechanisms mediating this improvement are unknown. In addition, while type 2 diabetes mellitus (T2D) disproportionately affects low-income racial and ethnic minority populations, it is unclear whether interventions targeting distress are differentially effective depending on participants’ baseline characteristics. Objective Our objective was to evaluate the mediators and moderators that would inform interventions for improvements in both glycemic control and diabetes distress. Methods Our target population included 290 Veterans Affairs patients with T2D enrolled in a comparative effectiveness trial of peer support alone versus technology-enhanced peer support with primary and secondary outcomes including HbA1c and diabetes distress at 6 months. Participants in both arms had significant improvements in both HbA1c and diabetes distress at 6 months, so the arms were pooled for all analyses. Goal setting, perceived competence, intrinsic motivation, and decisional conflict were evaluated as possible mediators of improvements in both diabetes distress and HbA1c. Baseline patient characteristics evaluated as potential moderators included age, race, highest level of education attained, employment status, income, health literacy, duration of diabetes, insulin use, baseline HbA1c, diabetes-specific social support, and depression. Results Among the primarily African American male veterans with T2D, the median age was 63 (SD 10.2) years with a baseline mean HbA1c of 9.1% (SD 1.7%). Improvements in diabetes distress were correlated with improvements in HbA1c in both bivariate and multivariable models adjusted for age, race, health literacy, duration of diabetes, and baseline HbA1c. Improved goal setting and perceived competence were found to mediate both the improvements in diabetes distress and in HbA1c, together accounting for 20% of the effect of diabetes distress on change in HbA1c. Race and insulin use were found to be significant moderators of improvements in diabetes distress and improved HbA1c. Conclusions Prior studies have demonstrated that some but not all interventions that improve diabetes distress can lead to improved glycemic control. This study found that both improved goal setting and perceived competence over the course of the peer support intervention mediated both improved diabetes distress and improved HbA1c. This suggests that future interventions targeting diabetes distress should also incorporate elements to increase goal setting and perceived competence. The intervention effect of improvements in diabetes distress on glycemic control in peer support may be more pronounced among White and insulin-dependent veterans. Additional research is needed to understand how to better target diabetes distress and glycemic control in other vulnerable populations.

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Section: Methodsmentioning

confidence: 99%