Impact of Community Based Peer Support in Type 2 Diabetes: A Cluster Randomised Controlled Trial of Individual and/or Group Approaches

Abstract

BackgroundDiabetes peer support, where one person with diabetes helps guide and support others, has been proposed as a way to improve diabetes management. We have tested whether different diabetes peer support strategies can improve metabolic and/or psychological outcomes.MethodsPeople with type 2 diabetes (n = 1,299) were invited to participate as either ‘peer’ or ‘peer support facilitator’ (PSF) in a 2x2 factorial randomised cluster controlled trial across rural communities (130 clusters) in England. Peer support was delivered over 8–12 months by trained PSFs, supported by monthly meetings with a diabetes educator. Primary end point was HbA1c. Secondary outcomes included quality of life, diabetes distress, blood pressure, waist, total cholesterol and weight. Outcome assessors and investigators were masked to arm allocation. Main factors were 1:1 or group intervention. Analysis was by intention-to-treat adjusting for baseline.ResultsThe 4 arms were well matched (Group n = 330, 1:1(individual) n = 325, combined n = 322, control n = 322); 1035 (79•7%) completed the mid-point postal questionnaire and 1064 (81•9%) had a final HbA1c. A limitation was that although 92.6% PSFs and peers were in telephone contact, only 61.4% of intervention participants attended a face to face session. Mean baseline HbA1c was 57 mmol/mol (7•4%), with no significant change across arms. Follow up systolic blood pressure was 2•3mm Hg (0.6 to 4.0) lower among those allocated group peer-support and 3•0mm Hg (1.1 to 5.0) lower if the group support was attended at least once. There was no impact on other outcomes by intention to treat or significant differences between arms in self-reported adherence or medication.ConclusionsGroup diabetes peer support over 8–12 months was associated with a small improvement in blood pressure but no other significant outcomes. Long term benefits should be investigated.Trial RegistrationISRCTN.com ISRCTN6696362166963621

Contributions of Peer Support to Health, Health Care, and Prevention: Papers from Peers for Progress

“…[17][18][19][20][21] Three papers in this supplement add to this evidence. Ayala and colleagues, 32 evaluated peer support provided by trained volunteers for Latino adults with diabetes in Southern California near the border with Mexico.…”

“…In Cambridgeshire, UK, 1,299 people enrolled for the peer support program, and 167 of these trained as peer support facilitators. 20 In a 6-month program in Cameroon, only 1 of 100 participants dropped out. 27 Emphasizing community partnerships, a peer support program for low-income African Americans in underserved, rural Alabama communities exceeded its recruitment goal of 400 participants.…”

“…However, interviews with peer supporters in projects in the UK, 20 Chicago 44 , and North Carolina 47 showed that, in practice, emotional support evolves over time, emerging out of instrumental support and the trust it builds. 48 An additional important feature of peer support is implicit emotional support, 49 the expression of emotional reassurance, acceptance and similar messages not through explicit discussion of feelings but through sharing of activities, discussions of common interests and the like.…”

“…Papers from these projects have documented the efficacy of peer support. [17][18][19][20][21] The present supplement to the Annals of Family Medicine includes additional evaluations of peer support interventions as well as papers addressing a number of issues in extending the reach and benefit of peer support. The accomplishments of Peers for Progress and the value of these latest additions to them can be clearly seen against the backdrop of the evidence needed to drive practical applications of peer support.…”

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

“…In all but 4 of the 17 trials (23.5%), the dropout rate was less than 20%. 21,27,33,35 None of the trials blinded participants, but 3 trials (17%) blinded outcomes assessors or investigators. Allocation concealment was not reported in 3 studies and not done in 1 study.…”