From clinic to community: A randomized controlled trial of a peer support model for adults with type 2 diabetes from specialty care settings in British Columbia

Abstract

Aims To examine the impact of a 12‐month peer‐led diabetes self‐management support intervention delivered via telephone amongst adults with type 2 diabetes (T2D) from specialty care settings in British Columbia (BC). Methods One‐hundred ninety‐six adults with T2D were randomly assigned to either a 12‐month Peer‐Led, Empowerment‐based, Approach, to Self‐management Efforts in Diabetes (PLEASED) intervention or a usual care condition. PLEASED involved weekly telephone contacts from a peer leader (PL) in the first 3 months followed by bi‐weekly telephone contacts in the last 9 months. Assessments were conducted at baseline, 3 and 12 months. The primary outcome was HbA1c; secondary outcomes included diabetes distress (DD), ApoB, systolic and diastolic blood pressure (BP), body mass index, waist circumference and depressive symptoms. Results No within or between group changes were observed for HbA1c at 3 or 12 months. However, amongst participants with HbA1c ≥ 69 mmol/mol (8.5%), the PLEASED group significantly lowered their HbA1c at 12 months [−11.7 mmol/mol (−1.07%); 95% CI: −20.7, −2.5 (−1.89, −0.23); p = 0.016] compared to usual care. Amongst secondary outcomes, within‐group improvements in overall DD were found at 3 months (−0.21; 95% CI: −0.35, −0.08; p = 0.002) for the PLEASED group and at 12 months for both groups (PLEASED: −0.35; 95% CI: −0.49, −0.21; p < 0.001 and control: −0.33; 95% CI: −0.47, −0.19; p < 0.001), however, no between‐group differences were observed. The PLEASED group improved systolic BP at 12 months (−5.4 mm Hg; 95% CI: −10.0, −0.8; p = 0.023) compared to usual care. Conclusions Participation in a peer support intervention in diabetes delivered via telephone leads to long‐term improvements in HbA1c amongst high‐risk adults with T2D living in BC. Trial registration: The study was registered on http://clinicaltrials.gov (NT02804620).

Recent Findings on the Effectiveness of Peer Support for Patients with Type 2 Diabetes

“…Peer Leader Supported Self-Care Intervention Although large numbers of patients with T2DM receive diabetes care in primary care settings, patients at the highest risk are often managed in subspecialty settings. Tang and colleagues conducted a peer-led intervention for adult T2DM patients presenting to endocrinology and diabetes education centers in British Columbia, Canada [32] and compared it to a usual care control group. Peer leaders completed 30 h of knowledge and skills training in T2DM self-management, providing emotional support, and linking patients to clinical resources.…”

Autopsy of a telephone‐based peer support intervention: Exploring participants' perspectives of and experiences with a self‐management support model for adults with type 2 diabetes from speciality care settings

“…The goal of this study was to ‘perform an autopsy’ on a telephone‐based, peer support intervention targeting adults with type 2 diabetes (T2D) from speciality care settings 19 . Specifically, the objectives of this study were to explore participants' experience with and perspective of the intervention and determine what modifications could be made to improve future iterations.…”

“…12 The goal of this study was to 'perform an autopsy' on a telephone-based, peer support intervention targeting adults with type 2 diabetes (T2D) from speciality care settings. 19 Specifically, the objectives of this study were to explore participants' experience with and perspective of the intervention and determine what modifications could be made to improve future iterations. Although this study does not focus on participant experience as it relates to clinical outcomes, it should be noted that this randomized controlled trial (RCT) found no difference in A1c between the intervention (i.e.…”