In individuals with poorly controlled diabetes, a reciprocal peer support programme gives greater 6-month improvement in HbA1c than does nurse care management
- Correspondence to Mary Carolan
School of Nursing and Midwifery, Victoria University, PO Box 14428, Melbourne, McKechnie Street, St Albans Vic 3021, VIC 8001, Australia;
Type 2 diabetes is a growing epidemic in developed countries, such as the USA, UK and Australia.1,–,3 It is significantly associated with early morbidity such as cardiovascular disease and nephropathy4 and with excess health expenditure.5 When type 2 diabetes is well managed, however, risks are greatly reduced.6–7 This study explored the utility of a matched peer support programme to improve diabetes outcomes among US veterans.
In this randomised controlled trial (n=244), inclusion criteria were based on the following: (1) diagnosis of diabetes and (2) HbA1c levels >7.5% in the previous 6 months. Participants were accessed via the US Department of Veterans facilities. Outcome measures included (1) changes over 6 months to baseline HbA1c levels and (2) physiological measures such as blood pressure. Participants in the intervention group were matched to same aged peers with diabetes and advised to maintain at least weekly phone contact for reciprocal support. The control group received enhanced usual care.
Patients, research staff and nurse care managers were blinded to random allocation of participants until all baseline data, including physiological measures, were collected. Nurse care managers were not blinded to the intervention as this was not possible. The same nurse care managers co-ordinated group sessions for intervention and control groups.
Results showed early promise, and mean HbA1c levels decreased by 0.29% in the intervention group. This is an important finding as strict HbA1c control is significantly associated with a delay in onset and a decrease in severity of diabetes-related morbidity. This work builds on earlier research that indicates that peer support programmes are useful for sufferers of chronic conditions and can lead to improved support and greater adherence to treatment plans.8 However, uptake is generally low, and many assigned patients do not attend support sessions.9
This study applied a novel approach of matching peers for reciprocal support. Implications for care include the development of greater supports for sufferers of diabetes, particularly in resource poor settings. This initiative has the potential to improve patient outcomes and satisfaction while at the same time easing the burden of an overstretched healthcare system. Widespread implementation of this sort of peer support programme may, however, be difficult. Such peer support programmes tend to be more successful among peers who share a cultural or social milieu, as in this case where all were US army veterans. In broad-based clinical practice, it may be difficult to match peers so exactly.
There were several questions that remained unanswered in this study. First, the term type 2 diabetes was not explicitly mentioned, although it appeared that type 2 diabetes was the main focus. There is also reference to an increase in insulin use in the intervention group, and this is explained by the authors as likely related to greater support to overcome patient resistance to insulin commencement. It is not discussed as possibly contributing to improved HbA1c levels. Acknowledged limitations include the homogeneity of the sample and the short duration of the study (ie, 6 months). Larger and broader trials need to establish whether this trend of improvement of HbA1c levels is replicable in a broader sample of diabetes patients.
Competing interests None.