Study Suggests Peer Support Improves Diabetes Outcomes

BACKGROUND:
Many patients with diabetes would benefit from self-management assistance between clinic visits. Studies have shown that nurse-led management programs improve diabetes self-care and risk factor control, but delivering these services may be difficult due to staff resources required for intensive care management. Peer support could allow patients to share experiences and receive reinforcement while requiring less time of clinicians. To test whether peer support would be an effective alternative to one-to-one nurse care management, investigators designed and piloted a novel intervention that supplements periodic nurse-led group sessions with telephone-based peer support between pairs of Veterans with diabetes (reciprocal peer support). This study compared the effectiveness of the peer-support program with nurse care management alone in improving glycemic control in a real-world clinical setting. All Veterans in this study received diabetes care at two Midwestern VA healthcare facilities from 4/07 to 4/09, and were identified as having had poor glycemic control prior to the study. Patients randomized to the peer support group (N=125) were given training at baseline on creating a plan to manage their diabetes and on peer counseling, encouraged to call their partner at weekly intervals, and invited to 3 face-to-face group sessions. Patients randomized to nurse care-management (N=119) had a one-to-one session with a nurse care manager at baseline and were encouraged to call with any problems. The primary outcome measure for this study was change in HbA1c between baseline and six months.

FINDINGS:

• Among Veterans with diabetes, periodic nurse-facilitated, patient-driven group sessions supplemented with one-on-one peer-support telephone calls (RPS group) improved glycemic control and other key outcomes more than nurse care management services alone (NCM group).
• RPS participants achieved HbA1c levels on average 0.58% lower than those randomized to the NCM group. RPS participants with a baseline HbA1c >8.0% achieved a mean decrease of 0.88% compared with a 0.07% decrease among NCM participants. These are clinically significant differences because a 0.5% mean difference in HbA1c translates into a 2.8% absolute risk reduction in diabetes events over a 10-year period.
• More Veterans assigned to peer-support started insulin than those assigned to nurse care management (8 vs. 1), and peer-support participants reported greater increases in diabetes-specific social support at six months.

LIMITATIONS:

• Investigators targeted male Veterans in the same age cohort who often have a common sense of “Veteran identity;” thus, it will be important to replicate this study in other gender-mixed cohorts.
• This intervention was only six months long. It will be important to test peer-support interventions over longer periods of time.
• Because the same nurse care managers provided care to patients in both groups, treatment bias cannot be excluded.

AUTHOR/FUNDING INFORMATION:
This study was partly funded through HSR&D (IIR 04-239), and Dr. Piette is supported by an HSR&D Research Career Scientist Award. All authors are part of HSR&D’s Center for Clinical Management Research in Ann Arbor, MI.

Heisler M, Vijan S, Makki F and Piette J. Diabetes Control with Reciprocal Peer Support Versus Nurse Care Management: A Randomized Trial, Annals of Internal Medicine October 19, 2010;153(8):507-15.