Peer support for patients with type 2 diabetes: cluster randomised controlled trial

Abstract

Objective To test the effectiveness of peer support for patients with type 2 diabetes. Design Cluster randomised controlled. Setting 20 general practices in the east of the Republic of Ireland. Participants 395 patients (192 in intervention group, 203 in control group) and 29 peer supporters with type 2 diabetes. Intervention All practices introduced a standardised diabetes care system. The peer support intervention ran over a two year period and contained four elements: the recruitment and training of peer supporters, nine group meetings led by peer supporters in participant's own general practice, and a retention plan for the peer supporters. Main outcome measures HbA 1c ; cholesterol concentration; systolic blood pressure; and wellbeing score. Results There was no difference between intervention and control patients at baseline. All practices and 85% (337) of patients were followed up. At two year follow-up, there were no significant differences in HbA 1c (mean difference −0.08%, 95% confidence interval −0.35% to 0.18%), systolic blood pressure (−3.9 mm Hg, −8.9 to 1.1 mm Hg), total cholesterol concentration (−0.03 mmol/L, −0.28 to 0.22 mmol/L), or wellbeing scores (−0.7, −2.3 to 0.8).While there was a trend towards decreases in the proportion of patients with poorly controlled risk factors at follow-up, particularly for systolic blood pressure (52% (87/166) >130 mm Hg in intervention v 61% (103/169) >130 mm Hg in control), these changes were not significant. The process evaluation indicated that the intervention was generally delivered as intended, though 18% (35) of patients in the intervention group never attended any group meetings. Conclusions A group based peer support intervention is feasible in general practice settings, but the intervention was not effective when targeted at all patients with type 2 diabetes. While there was a trend towards improvements of clinical outcomes, the results do not support the widespread adoption of peer support. Trial registration Current Controlled Trials ISRCTN42541690.

Implementation of the Chronic Care Model in Small Medical Practices Improves Cardiovascular Risk but Not Glycemic Control

“…A recent study (30) with similar methodology assessed, for instance, the effect of peer support for patients with type 2 diabetes but could not show significant differences between groups in the improvement of the cardiovascular risk factors. In another study (31), patients with newly diagnosed type 2 diabetes received a 6-h structured group educational intervention, but no significant differences in the change in (16) 59 (12) 59 (13) 56 (10) ,0.…”

A Randomized Trial of Peer Coach and Office Staff Support to Reduce Coronary Heart Disease Risk in African-Americans with Uncontrolled Hypertension

“…23 However, an Irish trial of peer education to reduce CHD risk reported no benefit, but lacked a theoretical basis and required subjects to attend nine office-based didactic group sessions led by peers. 24 Our intervention was structured by the Theory of Planned Behavior and emphasized interactive role modeling, phone outreach, and practical, culturally appropriate tips. 25 In addition to peer support, African-American practice staff provided counseling with entertaining, culturally appropriate, educational slideshows and an interactive computer-based CHD tool.…”

Patient generated “frequently asked questions”: Identifying informational needs in a RCT of peer support in type 2 diabetes

“…The full details of the intervention components and the training received by peer supporters is reported elsewhere [10] and summarized in Box 1.…”

“…29 peer support groups were formed in the ten intervention practices. The primary outcomes of the trial (HbA1c, blood pressure, total cholesterol, and the Diabetes Well-being score) are reported elsewhere [10]. The peer supporters were trained to conduct nine group meetings in their general practice over a period of two years.…”

“…Peer support may provide an opportunity to address some of these areas. Participants in a pilot study within the exploratory phase of a randomized controlled trial of peer support in type 2 diabetes [10] requested a system to address questions that arose from the peer group for which a professional response was deemed helpful [11]. This was discussed among the trialists and as a result an opportunity was Version 1 provided for the groups to identify questions in each session that they could not answer but would like answered with professional input.…”