2011 HSR&D National Meeting Abstract
1051 — A Randomized Controlled Trial of Peer Mentoring and Financial Incentive to Improve Glucose Control in African American Veterans
Long JA (Philadelphia CHERP), Jahnle E
(University of Pennsylvania), Richardson DM
(Philadelphia CHERP), Volpp KG
Minority populations have disproportionately high rates of diabetes mellitus (DM), poor DM control, and the consequences of poor control -- micro-vascular complications. Interventions that improve DM control in minority veterans have the potential to reduce important health disparities. In this study, we conducted a randomized controlled trial to test the effectiveness of peer mentoring and financial incentives in improving glucose control relative to usual care.
All participants were African America veterans, with persistently poor DM control, between the ages of 50 and 70 years. Participants were randomized to one of three arms [usual care (UC), peer mentoring (PM), or financial incentives (FI)], with follow-up 6 months after enrollment. Patients in the PM arm were matched to a trained mentor. Mentors were called monthly to reinforce the training and were given $20 a month for speaking with their mentee at least four times/month. Patients in the incentive arm were given $100 for a 1 point reduction in HbA1c and $200 for a 2 point reduction over 6 months.
A total of 118 veterans were enrolled and randomized to the 3 arms (39 to UC, 39 to PM, and 40 to FI). The mean baseline HbA1c by arm was: UC arm 9.9 (SD 1.6), PM arm 9.8 (SD 1.8), and FI arm 9.5 (SD 1.5). We used an intention to treat analysis and assumed no change from baseline in HbA1c for those lost to follow-up. We lost 0 people in the UC arm, 2 in the PM arm, and 4 in the FI arm. In analyses adjusting for baseline HbA1c, relative to the controls the HbA1c dropped by 1.01 points in the PM arm (95% CI 0.16:1.86) and 0.48 points in the FI arm (95% CI -0.39:1.35). Hypoglycemic events were rare and did not vary by arm.
Peer mentors had a strong and statistically significant effect in improving glucose control in a population of veterans with persistently poor DM control, whereas financial incentives did not.
Peer mentors may be a relatively low-cost and culturally sensitive means to improving glucose control and reducing racial disparities in diabetic outcomes.