Pairing people with diabetes who are struggling to control their blood sugar levels with their peers for weekly support sessions could be an effective and inexpensive way to help manage the disease, researchers say.
Such a programme was linked with significantly reduced blood sugar levels in male veterans with diabetes, according to a study appearing in the Archives of Internal Medicine.
The authors initially identified almost 1,700 veterans who might be eligible for the trial, but were only able to enroll 244. The 200-plus participants, all male, were randomised either to be matched up with another diabetes patient for weekly peer support and the option of attending group sessions, or to undergo one session of educational training and then receive care from a nurse care manager.
According to study author Dr Michele Heisler, this model of peer support is less hierarchical than most systems in the United States.
What the study revealed
"We explicitly wanted to test whether patients who were having self-management challenges and ... [who] had dangerously high blood sugar levels over the prior three months ... might be better motivated themselves if given the opportunity to both help and receive help from another participant facing similar self-management challenges and who also had poor control," explained Heisler, who is a research scientist with the Center for Clinical Management Research at the Ann Arbor VA.
This appeared to be the case: men in the peer-support group saw a significant drop in their HbA1c levels (a measure of blood sugar over time) - from an average of 8.02 to 7.73% over six months, which represented a 0.58% decrease from those in the control group, who received care from a nurse.
"That is equivalent to adding a new oral anti-hyperglycemic medication and a very clinically significant difference," said Heisler, who is also associate professor of internal medicine and health behavior and health education at the University of Michigan Medical School.
Blood pressure dropped slightly (although not significantly) in both groups, and no adverse effects were noted in either. Eight patients in the peer group also started on insulin during the trial, as opposed to just one in the control group, indicating that peer support may also be instrumental in convincing often-resistant patients to initiate insulin therapy, the authors stated.
Short-term outcomes better
Further study is needed to tease out which parts of a peer group intervention are most successful, concluded the authors, who noted that their research was limited in that it involved only men, lasted just six months, and was not a double-blind study.
In addition to the weekly telephone calls, patients in the peer group met about four-and-a-half hours more than those in the control group, which probably accounted for at least some of the improvement, said Dr Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Centre in New York City.
"In diabetes, every time we spend more time with the patient - it could be a [nurse], a physician, or a Johnny-do-gooder, it reminds the patient to do something or to be more engaged," he said. "The outcomes short-term tend to be better."
Zonszein pointed out that almost 1,000 veterans contacted declined to participate, a fact which he said may not bode well for the success of this type of system in the real world.
However, he said, such programmes may "play a role, especially in minority populations where either language or ethnicity is very different from the traditional population. They really help the bridging between health-care providers."
Peer educators may "almost be better suited for [certain] important ingredients of diabetes self-management," added Sharon Movsas, a certified diabetes educator who, like Zonszein, is with Montefiore Clinical Diabetes Center.
"The patient needs to feel empowered and confident... It's not so much knowing what to eat but 'how am I going to change my behaviour?' That involves problem-solving and goal-setting skills and the evidence shows that ... the person can relate better to a peer who might have more similarities than a teacher in the front of the room."
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