Integration and Utilization of Peer Leaders for Diabetes Self-Management Support: Results From Project SEED (Support, Education, and Evaluation in Diabetes)

Abstract

Purpose The purpose of the study was to evaluate the effectiveness of a peer leader-led (PL) diabetes self-management support (DSMS) group in achieving and maintaining improvements in A1C, self-monitoring of blood glucose (SMBG), and diabetes distress in individuals with diabetes. Diabetes self-management support is critical; however, effective, sustainable support models are scarce. Methods The study was a cluster randomized controlled trial of 221 people with diabetes from 6 primary care practices. Practices and eligible participants (mean age: 63.0 years, 63.8% female, 96.8% white, 28.5% at or below poverty level, 32.5% using insulin, A1C ≥7%: 54.2%) were randomized to diabetes self-management education (DSME) + PL DSMS (n = 119) or to enhanced usual care (EUC) (DSME + traditional DSMS with no PL; n = 102). Data were collected at baseline, after DSME (6 weeks), after DSMS (6 months), and after telephonic DSMS (12 months). Results Decreases in A1C occurred between baseline and post-DSME in both groups. Both groups sustained improvements during DSMS, but A1C levels increased during telephonic DSMS. Improvements in self-monitoring of blood glucose were observed in both groups following DSME and were sustained throughout. At study end, the intervention group was 4.3 times less likely to have diabetes regimen-related distress compared to EUC. Conclusions PL DSMS is as effective as traditional DSMS in helping participants to maintain glycemic control and self-monitoring of blood glucose (SMBG) and more effective at improving distress. With increasing diabetes prevalence and shortage of diabetes educators, it is important to integrate and use low-cost interventions in high-risk communities that build on available resources.

Exploration of Users’ Perspectives and Needs and Design of a Type 1 Diabetes Management Mobile App: Mixed-Methods Study

“…Peer leaders can play leading, interactive, and cohesive roles and can improve the atmosphere of a peer support module. Internet-based mentoring programs can increase the frequency of blood sugar monitoring [ 46 ], and studies have demonstrated that peer leaders can provide effective diabetes self-management support [ 47 , 48 ]. However, exchanges in current diabetes apps all take the form of forums, which is inconvenient.…”

Improving Self-Care Management in Low-Income Latinos With Type 2 Diabetes Using Peer-Led U.S. Conversation Maps: A Quality Improvement Project in a Free Clinic

“…Subgroup analysis from this review suggested that culturally tailored DSME interventions involving both trained diabetes educators and peer educators may provide the greatest benefit (9). Peer-led diabetes selfmanagement, a potential low-cost, flexible modality, has been found to successfully maintain key improvements in A1C in rural communities (11,12). Providing bicultural/ bilingual educational materials and involving team members from the community can enhance the cultural sensitivity of DSME programs (13).…”

An Effective Model of Diabetes Care and Education: The ADCES7 Self-Care Behaviors™

“…Peer support has shown benefits, including social, emotional, and cultural support. 52-55 Various models of peer support exist, with the potential to improve self-efficacy, positive mood, understanding of self-care, and perception of social support as well as improve health-related outcomes. 56 People living with chronic disease are not the only ones who may require this support; family members, caregivers, and partners of people with diabetes can experience diabetes distress.…”