April 3, 2012
Judith Long, M.D., core investigator with the VA HSR&D Center for Health Equity and Promotion, recently published a study in the Annals of Internal Medicine that showed that African American Veterans with hard-to-control diabetes who were matched with peer mentors made significant gains in keeping their blood sugar in check. The study results were also featured in The New York Times' Well blog on March 22.
The investigation conducted by Dr. Long and her colleagues included 118 African American Veterans, all of whom were having trouble controlling their diabetes. One group received telephone counseling from peer mentors—other African American Veterans with diabetes who had overcome their own struggles to keep their blood sugar at healthy levels. After a brief training session, the mentors earned a small reward—$20 per month—if they contacted the person they were helping at least once a week throughout the six-month study. A second group received usual care—standard medical care, with no additional supports. A third group became eligible for a payment of up to $200 at the end of the study if they were able to significantly lower their blood sugar.
Of the three arms, the peer group made the most progress. On average, their hemoglobin A1C—a measure of blood sugar over the past two to three months—dropped about a point, from 9.8 to 8.7 percent. Good control for those with diabetes is considered around 7.5 to 8 percent. The usual-care group saw only a slight drop in their hemoglobin A1C levels, from 9.9 to 9.8 percent. The financial incentive group showed a modest improvement—from 9.5 to 9.1 percent—but it was not statistically significant.
Because the pilot study lasted only six months and the study population was relatively small, the authors say further research is needed, but overall, these results are in line with previous investigations in which mentoring or reciprocal peer support helped patients with diabetes improve their medication adherence, diet, exercise, blood glucose monitoring, and glucose control.
Dr. Long's co-Investigators were Kevin G. Volpp, MD, PhD and Diane M. Richardson, PhD, of VA's Center for Health Equity Research and Promotion in Philadelphia, along with colleagues Erica C. Jahnle, BA, from the University of Pennsylvania, and George Loewenstein, PhD, of Carnegie Mellon University. Funding was provided by VA and the National Institute on Aging.