Effectiveness of a Peer Support Programme versus Usual Care in Disease Management of Diabetes Mellitus Type 2 regarding Improvement of Metabolic Control: A Cluster-Randomised Controlled Trial

Effect of peer support interventions in patients with type 2 diabetes: A systematic review

OBJECTIVE

This study aims to assess the effectiveness of a peer support intervention on the quality of life (QOL), self-management, self-efficacy, glycated hemoglobin (HbA1c), and depression in patients with type 2 diabetes mellitus (T2DM).

METHODS

A systematic review was conducted by searching 10 databases, namely PubMed, The Cochrane Library, Embase, Medline, CINHAL, Web of Science, Sinomed, CNKI, WanFang Data, and VIP for articles published from January 1974 to April 2023.

RESULTS

A total of 12 studies were included. A narrative synthesis of the results showed that peer support significantly improved QOL, self-management, self-efficacy, and HbA1c control in patients with T2DM, but had no significant effect on depression.

CONCLUSION

Peer support is an effective intervention for individuals with T2DM. Future research should focus on more rigorously designed and larger-sample studies.

PRACTICE IMPLICATIONS

Peer support proves to be effective for managing patients with T2DM. Current peer support interventions can provide valuable ideas that can guide the direction of future research.

What is the volume, diversity and nature of recent, robust evidence for the use of peer support in health and social care? An evidence and gap map

Background

Peer support interventions involve people drawing on shared personal experience to help one another improve their physical or mental health, or reduce social isolation. If effective, they may also lessen the demand on health and social care services, reducing costs. However, the design and delivery of peer support varies greatly, from the targeted problem or need, the setting and mode of delivery, to the number and content of sessions. Robust evidence is essential for policymakers commissioning peer support and practitioners delivering services in health care and community settings. This map draws together evidence on different types of peer support to support the design and delivery of interventions.

Objectives

The aim of this map was to provide an overview of the volume, diversity and nature of recent, high quality evidence on the effectiveness and cost-effectiveness of the use of peer support in health and social care.

Search Methods

We searched MEDLINE, seven further bibliographic databases, and Epistemonikos for systematic reviews (in October 2020), randomised controlled trials (in March 2021) and economic evaluations (in May 2021) on the effectiveness of peer support interventions in health and social care. We also conducted searches of Google Scholar, two trial registers, PROSPERO, and completed citation chasing on included studies.

Selection Criteria

Systematic reviews, randomised controlled trials and economic evaluations were included in the map. Included studies focused on adult populations with a defined health or social care need, were conducted in high-income countries, and published since 2015. Any measure of effectiveness was included, as was any form of peer support providing the peer had shared experience with the participant and a formalised role.

Data Collection and Analysis

Data were extracted on the type of peer support intervention and outcomes assessed in included studies. Standardised tools were used to assess study quality for all studies: assessing the methodological quality of systematic reviews 2 for systematic reviews; Cochrane risk of bias tool for randomised controlled trials; and consensus health economic criteria list for economic evaluations.

Main Results

We included 91 studies: 32 systematic reviews; 52 randomised controlled trials; and 7 economic evaluations. Whilst most included systematic reviews and economic evaluations were assessed to be of low or medium quality, the majority of randomised controlled trials were of higher quality. There were concentrations of evidence relating to different types of peer support, including education, psychological support, self-care/self-management and social support. Populations with long-term health conditions were most commonly studied. The majority of studies measured health-related indicators as outcomes; few studies assessed cost-effectiveness. Studies were unevenly distributed geographically, with most being conducted in the USA. Several gaps were evident regarding the delivery of peer support, particularly the integration of peers and professionals in delivering support and interventions of longer duration.

Authors' Conclusions

Although there is evidence available to inform the commissioning and delivery of peer support in health and social care, there are also clear gaps that need to be addressed to further support provision, particularly regarding cost-effectiveness. The effectiveness of peer support in different countries, with varying health and social care systems, is a priority for future research, as is the integration of peers with professionals in delivering peer support.

Improving glycemic control in patients with type 2 diabetes mellitus through a peer support instant messaging service intervention (DiabPeerS): study protocol for a randomized controlled trial

Background

Diabetes mellitus is one of the four priority non-communicable diseases worldwide. It can lead to serious long-term complications and produces significant costs. Due to the chronicle character of the disease, it requires continuous medical treatment and good therapy adherence of those suffering. Therefore, diabetes self-management education (DSME) (and support DSMES) plays a significant role to increase patient’s self-management capacity and improve diabetes therapy. Research indicates that these outcomes might be difficult to maintain. Consequently, effective strategies to preserve the positive effects of DSMES are needed. Preliminary results show that peer support, which means support from a person who has experiential knowledge of a specific behavior or stressor and similar characteristics as the target population, is associated with better outcomes in terms of HbA_1c, cardiovascular disease risk factors or self-efficacy at a lower cost compared to standard therapy. Peer-supported instant messaging services (IMS) approaches have significant potential for diabetes management because support can be provided easily and prompt, is inexpensive, and needs less effort to attend compared to standard therapy. The major objective of the study is to analyze the impact of a peer-supported IMS intervention in addition to a standard diabetes therapy on the glycemic control of type 2 diabetic patients.

Methods

A total of 205 participants with type 2 diabetes mellitus will be included and randomly assigned to an intervention or control group. Both groups will receive standard therapy, but the intervention group will participate in the peer-supported IMS intervention, additionally. The duration of the intervention will last for 7 months, followed by a follow-up of 7 months. Biochemical, behavioral, and psychosocial parameters will be measured before, in the middle, and after the intervention as well as after the follow-up.

Discussion

Type 2 diabetes mellitus and other non-communicable diseases put healthcare systems worldwide to the test. Peer-supported IMS interventions in addition to standard therapy might be part of new and cost-effective approaches to support patients independent from time and place.

Trial registration

ClinicalTrials.govNCT04797429. Registered on 15 March 2021.

Are quality promotion initiatives in Austrian and Italian general practices associated with higher patient satisfaction and quality of life? Results from the interventional study 'IQuaB'

The objective was to assess the changes in quality of life (QoL) and patient satisfaction of chronically ill patients in general practices in Salzburg (Austria) and South Tyrol (Italy) after implementation of a combined intervention addressing quality of care of general practitioners (GPs). Furthermore, the correlation between QoL/patient satisfaction and quality of care provided by the GPs (measured by a quality score based on quality indicators [QIs]) was investigated. The non-controlled pre-post study involved GPs and patients with chronic conditions. The intervention consisted of self-audit, benchmarking and quality circles. QIs were extracted in the participating practices in 2012 (preintervention) and 2014 (postintervention). Before and after the intervention, a patient survey was conducted including EQ-5D (measuring health-related QoL), a patient participation scale and parts of the European Task Force on Patient Evaluations of General Practice questionnaire (measuring patient satisfaction). Mann-Whitney U-tests, chi-square tests and Spearman's rank correlation were applied for statistical analysis. Fifty-six GPs participated in the study. 1,710 patients returned the questionnaire in 2012, and 1,374 in 2014. Mean EQ-5D index (QoL) was similar in Salzburg and South Tyrol in both years: 2012 Salzburg 0.85 (95% CI 0.84-0.87), South Tyrol 0.85 (95% CI 0.84-0.86); 2014 Salzburg 0.84 (95% CI 0.83-0.86), South Tyrol 0.84 (95% CI 0.83-0.86). Patient satisfaction was higher in Salzburg than in South Tyrol at baseline (EUROPEP: mean percentage of best response 61.5% vs. 49.1%, p < 0.000) and also at follow-up (61.9% vs. 49.2%; p < 0.000). No significant correlation between quality score and QoL/patient satisfaction was detected. Thus, the impact of the intervention was not significant within the intermediate time periods analysed in the study. Improvements in quality of care do not necessarily also improve patient-relevant outcomes, which are probably more associated with other factors than with medical quality (e.g. availability of the GP, waiting times and communication-related issues).

Trained Volunteers With Type 2 Diabetes Experience Significant Health Benefits When Providing Peer Support

Trained lay volunteers may have value in supporting lifestyle change programs in the prevention of type 2 diabetes, but the potential health benefits (or harms) experienced by these lay volunteers have not been well described. This is important, as this is an appealing model in terms of workforce planning. The aim of the prespecified quantitative study reported here, was to examine the possible health benefits or harms experienced by these trained lay volunteers with type 2 diabetes. In a large type 2 diabetes prevention program, we recruited and trained 104 lay volunteers with type 2 diabetes themselves, to act as diabetes prevention mentors and codeliver the lifestyle intervention. Mentors made motivational telephone calls to 461 participants randomized to one of the trial arms to encourage lifestyle changes. Weight, diet, physical activity, well-being, quality of life, diabetes-specific self-efficacy, and glycaemic control were measured at baseline, 12 and 24 months. Average mentor age was 62.0 years, 57 (54.8%) were male, 92 (88.5%) were overweight or obese (BMI>30 kg/m²). At 12 months, mentor dietary behaviors (fat and fiber intake) improved significantly, sedentary time spent fell significantly, and diabetes specific self-efficacy scores significantly increased. These significant improvements, with no evidence of harms, suggest lay volunteers with type 2 diabetes codelivering a lifestyle intervention, may themselves experience health benefits from volunteering.

The effect of peer support on quality of life among type 2 diabetic patients in deprived areas in Iran: A randomized clinical trial

BACKGROUND

Quality of life (QOL) is one of the effective factors in promoting the health of diabetic patients. In recent years, the role of peer support in the optimal management of diabetes has gained increasing attention. However, contradictory results have been reported from the effectiveness of this method. This study aimed to investigate the effect of peer support on the QOL among type 2 diabetic patients in deprived areas.

MATERIALS AND METHODS

This study was a randomized clinical trial conducted on 80 patients with T2D referring to the diabetes Clinic in Aligoudarz in Iran. Participants were randomly assigned into two groups of 40 patients. Intervention group received a peer Supportive-educational program for 3 months and the control group received routine clinic care. Diabetes QOL brief clinical inventory was used to collect the data. This questionnaire was completed three times at the beginning of the study, immediately after the 3-day training, and after 3 months of peer supportive intervention. The SPSS software (v. 18.0) was used to analyze the data through the Generalized Estimating Equations.

RESULTS

There was no significant difference in mean QOL between the two groups before the intervention (P = 0.891) and immediately after the education (P = 0.076). However, after 3 months of intervention, the intervention group showed a significant improvement in mean QOL compared to those in the control group (P < 0.001).

CONCLUSION

Peer support program can improve the QOL in type 2 diabetic patients in deprived areas. Therefore, this method can be recommended to improve care and educational programs in these patients.

The effect of peer group on self-care behaviors and glycemic index in elders with type II diabetes

BACKGROUND

Diabetes is one of the most expensive and chronic diseases of elderly age. Knowledge and self-care behaviors play an important role in treating diabetes and preventing its side effects. This study aimed to investigate the effect of peer group on self-care behaviors and glycemic index in the elderly with type II diabetes mellitus in Fasa city, Fars province.

MATERIALS AND METHODS

This quasi-experimental study was conducted on 100 elderly patients with type II diabetes (50 patients in the intervention group and 50 in control group) referred to the diabetes center. Among the elderly, the intervention group was selected as a trainer based on the checklist of the peer group and was trained by the researcher. In addition to the usual care of the diabetes clinic, the patients in the intervention group received training from their peers for 8 weeks during 8-45 min of training sessions. Data were collected using a valid self-reported questionnaire including demographic variables, awareness, and diabetes self-care behaviors (Summary of Diabetes Self-care Activities), as well as free practice (fasting blood sugar [FBS] and hemoglobin A1c [HbA1c]), which was completed by both groups before and 2 months after the intervention. Then, the data were entered into the SPSS statistical software, version 22 and were analyzed using Chi-square test, independent t-test, and descriptive statistical methods. P < 0.05 was considered statistically significant.

RESULTS

The results showed that the two groups of intervention and test were identical in terms of demographic information. In the intervention group, before and after 2 months of educational intervention, there was a significant difference in increasing awareness and self-care behavior in diet, physical activity, blood sugar testing, foot care, and medication (P < 0.001). However, this difference was not significant in the control group (P < 0.05). In the intervention group, the mean FBS and quarterly (HbA1c) index decreased significantly (P < 0.05).

CONCLUSION

This study showed that teaching self-care program, in the same way, has been effective in improving self-care behavior and blood sugar index in the elderly with diabetes and suggested that this educational method be used in other chronic diseases.

Effects of psychosocial support interventions on survival in inpatient and outpatient healthcare settings: A meta-analysis of 106 randomized controlled trials

BACKGROUND

Hospitals, clinics, and health organizations have provided psychosocial support interventions for medical patients to supplement curative care. Prior reviews of interventions augmenting psychosocial support in medical settings have reported mixed outcomes. This meta-analysis addresses the questions of how effective are psychosocial support interventions in improving patient survival and which potential moderating features are associated with greater effectiveness.

METHODS AND FINDINGS

We evaluated randomized controlled trials (RCTs) of psychosocial support interventions in inpatient and outpatient healthcare settings reporting survival data, including studies reporting disease-related or all-cause mortality. Literature searches included studies reported January 1980 through October 2020 accessed from Embase, Medline, Cochrane Library, CINAHL, Alt HealthWatch, PsycINFO, Social Work Abstracts, and Google Scholar databases. At least 2 reviewers screened studies, extracted data, and assessed study quality, with at least 2 independent reviewers also extracting data and assessing study quality. Odds ratio (OR) and hazard ratio (HR) data were analyzed separately using random effects weighted models. Of 42,054 studies searched, 106 RCTs including 40,280 patients met inclusion criteria. Patient average age was 57.2 years, with 52% females and 48% males; 42% had cardiovascular disease (CVD), 36% had cancer, and 22% had other conditions. Across 87 RCTs reporting data for discrete time periods, the average was OR = 1.20 (95% CI = 1.09 to 1.31, p < 0.001), indicating a 20% increased likelihood of survival among patients receiving psychosocial support compared to control groups receiving standard medical care. Among those studies, psychosocial interventions explicitly promoting health behaviors yielded improved likelihood of survival, whereas interventions without that primary focus did not. Across 22 RCTs reporting survival time, the average was HR = 1.29 (95% CI = 1.12 to 1.49, p < 0.001), indicating a 29% increased probability of survival over time among intervention recipients compared to controls. Among those studies, meta-regressions identified 3 moderating variables: control group type, patient disease severity, and risk of research bias. Studies in which control groups received health information/classes in addition to treatment as usual (TAU) averaged weaker effects than those in which control groups received only TAU. Studies with patients having relatively greater disease severity tended to yield smaller gains in survival time relative to control groups. In one of 3 analyses, studies with higher risk of research bias tended to report better outcomes. The main limitation of the data is that interventions very rarely blinded personnel and participants to study arm, such that expectations for improvement were not controlled.

CONCLUSIONS

In this meta-analysis, OR data indicated that psychosocial behavioral support interventions promoting patient motivation/coping to engage in health behaviors improved patient survival, but interventions focusing primarily on patients' social or emotional outcomes did not prolong life. HR data indicated that psychosocial interventions, predominantly focused on social or emotional outcomes, improved survival but yielded similar effects to health information/classes and were less effective among patients with apparently greater disease severity. Risk of research bias remains a plausible threat to data interpretation.

The Effect of Peers Support on Fear of Hypoglycemia in Iranian Patients with Type 1 Diabetes: A Clinical Trial Study

Background

Fear of hypoglycemia is a medical emergency which leads to disrupt individuals' normal lives. Peers support is a hopeful approach to improve diabetes self-care behaviors. This study was conducted to assess the effect of peers support on the fear of hypoglycemia in patients with type 1 diabetes.

Materials and Methods

This randomized clinical trial study was performed among 60 patients with type 1 diabetes in Qazvin city from September 2019 to October 2020. Patients were assigned to control and intervention groups using a random method. The data collection tools included demographic characteristics and a standard questionnaire for Hypoglycemia Fear Survey (HFS). Patients in the intervention group were trained by skilled peers for 2 months, but those of the control group only received routine hospital training. The data were analyzed by SPSS version 16 and paired and independent t-test.

Results

The scores of the fear of hypoglycemia in diabetic patients in the two groups had no significant statistical difference before intervention (t₅₃ = 0.93, p = 0.94). But after the intervention, the independent t-test showed that there was a significant difference between the scores of the fear of hypoglycemia in both groups (t₅₃ = -2.13, p = 0.03).

Conclusions

Considering the results of the current study, peer support for diabetic patients is an effective way to reduce the fear of hypoglycemia. Therefore, it is recommended using this training method to train diabetic patients.

Volunteer Impact on Health-Related Outcomes for Seniors: a Systematic Review And Meta-Analysis

BACKGROUND

Volunteers are increasingly promoted to improve health-related outcomes for community-dwelling elderly without synthesized evidence for effectiveness. This systematic review and meta-analysis evaluates the effects of unpaid volunteer interventions on health-related outcomes for such seniors.

METHODS

MEDLINE, EMBASE and Cochrane (CENTRAL) were searched up to November 2018. We included English language, randomized trials. Two reviewers independently identified studies, extracted data, and assessed evidence certainty (using GRADE). Meta-analysis used random-effects models. Univariate meta-regressions investigated the relationship between volunteer intervention effects and trial participant age, percentage females, and risk of bias.

RESULTS

28 included studies focussed on seniors with a variety of chronic conditions (e.g., dementia, diabetes) and health states (e.g., frail, palliative). Volunteers provided a range of roles (e.g., counsellors, educators and coaches). Low certainty evidence found that volunteers may improve both physical function (MD = 3.2 points on the 100-point SF-36 physical component score [PCS]; 95% CI: 1.09, 5.27) and physical activity levels (SMD = 0.5, 95% CI: 0.14 to 0.83). Adverse events were not increased.

CONCLUSION

Volunteers may increase physical activity levels and subjective ratings of physical function for seniors without apparent harm. These findings support the WHO call to action on evidence-based policies to align health systems in support of older adults.

"JUMPing into Diabetes Control": A Group-Setting Self-Empowerment Lifestyle Intervention among Diabetes Patients

We examined the impact of a group-based self-empowerment intervention among diabetes patients, which uses multidisciplinary education, collaborative learning, peer support, and development of diabetes-specific social capital to improve glycemic control and weight management. Thirty-five patients who had primary care established at the Prisma Health Upstate, Internal Medicine Resident clinic and held the diagnosis of diabetes for longer than one year were recruited for our single-arm pilot intervention. Each group intervention session involved one to two internal medicine resident physician facilitators, a clinical diabetic educator, and 5–10 patients. Each session had a framework facilitated by the resident, with most of the discussion being patient-led, aiming to provide a collaborative learning environment and create a support group atmosphere to encourage self-empowerment. Patients’ hemoglobin A1c level and body mass index (BMI) before the intervention and 3 to 6 months after completion were collected from the laboratory results obtained in the participants’ routine clinic visits. All graduates from this three-week intervention were invited to attend monthly maintenance sessions, and we tracked the HgbA1c measures of 29 JUMP graduates one year after the intervention, even though 13 of the 29 chose not to participate in the monthly maintenance sessions. The pre-intervention HgbA1c level averaged 8.84%, whereas the post-intervention HgbA1c level averaged 7.81%. A paired t test showed that this pre–post difference of 1.03 percentage points was statistically significant (p = 0.0007). For BMI, there was an average decline of 0.78 from the pre-intervention mean value of 40.56 to the post-intervention mean value of 39.78 (p = 0.03). Among the 29 participants who agreed to participate in our follow-up measure of their HgbA1c status one year after the intervention, a paired t test showed that there was no significant difference between the post-JUMP measure and the follow-up measure (p = 0.808). There was no statistically significant difference between the HgbA1c level of those participating in the maintenance program and that of those not participating (post-intervention t test of between-group difference: p = 0.271; follow-up t test of between-group difference: p = 0.457). Our single-arm, pilot study of the three-week group intervention of self-empowerment shows promising results in glycemic control and weight loss. The short duration and small number of sessions expected could make it more feasible for implementation and dissemination as compared with popular intervention protocols that require much longer periods of attendance, if the effectiveness of this patient group-based self-empowerment approach can be further established by randomized controlled studies in the future.

A comparative effectiveness trial of an information technology enhanced peer-integrated collaborative care intervention versus enhanced usual care for US trauma care systems: Clinical study protocol

Annually approximately 2-3 million Americans are so severely injured that they require inpatient hospitalization. The study team, which includes patients, clinical researchers, front-line provider and policy maker stakeholders, has been working together for over a decade to develop interventions that target improvements for US trauma care systems nationally. This pragmatic randomized trial compares a multidisciplinary team collaborative care intervention that integrates front-line trauma center staff with peer interventionists, versus trauma team notification of patient emotional distress with mental health consultation as enhanced usual care. The peer-integrated collaborative care intervention will be supported by a novel emergency department exchange health information technology platform. A total of 424 patients will be randomized to peer-integrated collaborative care (n = 212) and surgical team notification (n = 212) conditions. The study hypothesizes that patient's randomized to peer integrated collaborative care intervention will demonstrate significant reductions in emergency department health service utilization, severity of patient concerns, post traumatic stress disorder symptoms, and physical limitations when compared to surgical team notification. These four primary outcomes will be followed-up at 1- 3-, 6-, 9- and 12-months after injury for all patients. The Rapid Assessment Procedure Informed Clinical Ethnography (RAPICE) method will be used to assess implementation processes. Data from the primary outcome analysis and implementation process assessment will be used to inform an end-of-study policy summit with the American College of Surgeons Committee on Trauma. The policy summit will facilitate acute care practice changes related to patient-centered care transitions over the course of a single 5-year funding cycle. Trial registration: (Clinicaltrials.govNCT03569878).

Peer support interventions in type 2 diabetes: Review of components and process outcomes

BACKGROUND

This review seeks to identify (a) the various components and process outcomes of type 2 diabetes peer support (PS) interventions and (b) the measures implemented to monitor intervention fidelity and evaluate outcomes in these studies.

METHODS

The MEDLINE, PubMed, EMBASE (Excerpta Medica Database), CENTRAL (Cochrane Central Register of Controlled Trials), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO databases were searched from inception to May 2019. Two reviewers independently screened and extracted data from eligible articles via the Template for Intervention Description and Replication (TIDieR) checklist (why, what, who provided, how, where, when and how much, tailoring, modifications, and how well).

RESULTS

Twenty-three trials were included. The total number of participants was 7178. Most interventions were in primary care. Although face-to-face was the most common modality of contact, rates of contact were highest for telephone. Potential peer leaders (PLs) were identified primarily through recommendations from health professionals, based on their communication skills, glycosylated hemoglobin (HbA1c), and coaching interest. PLs were mostly female, university educated, and had a long history of diabetes (≥ 10 years). PL training varied significantly in length and content; the two most frequent topics were communication skills and diabetes knowledge. Although several studies implemented methods to evaluate "intervention fidelity," only few rigorously assessed the two key components of fidelity, "adherence" and "competence," through audio- and video-taping or direct observations.

CONCLUSIONS

The impact of PS on participants' health outcomes is well investigated; however, the implementation and evaluation strategies vary significantly across these studies. In the present review, we define the various components of PS interventions and propose suggestions for enhancing the implementation and evaluation of future PS models.

Association between quality of life, physical activity, use of medication and costs of treatment for chronic diseases in Primary Care

BACKGROUND

The aim of this study was to investigate the costs and the health outcomes of primary care treatments for chronic diseases and to analyze the association between domains of quality of life (QoL), physical activity and healthcare costs.

METHODS

The sample encompassed 292 patients aged 50 years or more in Brazilian primary care facilities, categorized in three groups: no drug treatment or only regular physical activity, only drug treatment, and drug treatment with regular physical activity. Patients were assessed in relation to quality of life, healthcare costs, regular physical activity, and use of medications.

RESULTS

Results indicate higher cost-utility ratio among primary care patients adopting only drug treatment (3.92), followed by drug treatment with regular physical activity (3.21), and no drug treatment or only regular physical activity (0.12).

CONCLUSIONS

QoL was significantly associated with risk factors for chronic diseases, especially obesity, and limitations in mobility showed important increases in healthcare costs. The dominant strategy in terms of cost-utility ratio was identified among primary care patients without drug treatment or physically active, followed by patients in drug treatment combined with regular physical activity. Drug treatment without regular physical activity showed worst results in relation to other primary care strategies.

Study protocol and baseline sample characteristics: From clinic to community: Using peer support as a transition model for improving long-term diabetes-related health outcomes

BACKGROUND

The objective of this randomized controlled trial is to examine the effects of a 12-month telephone-based peer-led diabetes self-management support (DSMS) intervention on long-term diabetes-related health outcomes.

METHODS

In total, 197 participants with type 2 diabetes were recruited from specialty care settings (diabetes and endocrinology clinics). They were randomly assigned to 1) a 12-month Peer-Led, Empowerment-based Approach to Self-management Efforts in Diabetes (PLEASED) program where they received 12 weekly contacts from their peer supporter (PS) in the first 3 months, followed by 18 biweekly telephone support contacts over the last 9 months, or 2) usual care. The primary clinical and psychosocial outcomes were HbA1c and diabetes distress (DD), respectively. Secondary outcomes were cardiovascular risk factors. Assessments were conducted at baseline, 3 months, and 12 months.

RESULT

Of 197 recruited participants, 49.7% were female. The majority of participants were married/partnered, well-educated, employed, and Caucasian, with a mean HbA1c of 8.09 ± 1.7. Forty-two percent of participants reported little or no distress. There was no significant difference between the two groups.

DISCUSSION

Despite evidence showing that individuals with poor glycemic control benefit the most from peer support interventions, the majority of such interventions have been designed for and implemented in community and primary care-based settings. The present study investigates a 12-month peer support model to help patients initiate and sustain effective self-management behaviors while transitioning from specialty care to a community setting. The study was completed in November 2018. The outcome data analyses are currently underway.

TRIAL REGISTRATION

The study was registered on clinicaltrials.gov (NT02804620).

PROTOCOL VERSION

The protocol version is 3.5.

Efficacy of a self-management education programme on patients with type 2 diabetes in primary care: A randomised controlled trial

AIM

The purpose of this study was to assess the efficacy of the Spanish Diabetes Self-Management Program (SDSMP) versus usual care in adults with type 2 diabetes mellitus (T2DM) residing in a Spanish region.

METHODS

A two-year follow-up randomised controlled trial. The intervention consisted of 6 weekly structured peer-to-peer workshops. The primary outcome was change in HbA1c levels. Secondary outcomes included other clinical measures, quality of life, self-efficacy, life-style changes, medication and use of healthcare services. Mixed effect models were fitted.

RESULTS

n=297 patients were recruited in each study arm. Baseline HbA1c levels were comparable in both groups with an overall mean 7.1 (SD=1.2). The intervention did not significantly modify HbA1c, or other cardiovascular variables. Significant improvements were seen in self-efficacy, and in particularly its disease control component. Certain differences were also observed in the use of healthcare resources and medication consumption. High workshop participation and satisfaction rates were achieved.

CONCLUSION

HbA1c reductions are difficult to obtain in adequately controlled patients. On the other hand, raising awareness on one's disease can increase disease control self-efficacy. This finding, accompanied by reduced medication consumption and healthcare use rates, highlights that usual care would be benefited by incorporating certain SDSMP aspects.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT01642394.

Effectiveness of peer led intervention in improvement of clinical outcomes among diabetes mellitus and hypertension patients-A systematic review and meta-analysis

Peer-led intervention allows the patients to develop knowledge, skills and confidence in managing their own conditions. Hence this review was done to assess the effectiveness of peer-led intervention in improving the clinical outcomes of DM and HTN patients. We conducted systematic search in Medline, CENTRAL, Sciencedirect and Google-Scholar from inception till May 2018 and retrieved 3654 citations. Meta-analysis was performed using random-effects model and pooled mean difference (MD) was reported with 95% CI. Publication bias was assessed using Egger's test. 29 trials (26 DM and 3 HTN) with 6363 participants were included. There was positive effect of peer led intervention on DM and HTN with pooled MD of -0.28% [95%CI: -0.45 to -0.11] and -7.52mmHg [95%CI: -14.39 to -0.66]. There was significant heterogeneity and publication bias in both DM and HTN trials. Sensitivity analysis showed only little improvement in the final estimate. Peer support intervention is effective and causes statistically significant reduction in HbA1C and systolic blood pressure among DM and HTN patients.

Recruitment, retention, and training of people with type 2 diabetes as diabetes prevention mentors (DPM) to support a healthcare professional-delivered diabetes prevention program: the Norfolk Diabetes Prevention Study (NDPS)

OBJECTIVE

Intensive lifestyle interventions reduce the risk of type 2 diabetes in populations at highest risk, but staffing levels are usually unable to meet the challenge of delivering effective prevention strategies to a very large at-risk population. Training volunteers with existing type 2 diabetes to support healthcare professionals deliver lifestyle interventions is an attractive option.

METHODS

We identified 141 973 people at highest risk of diabetes in the East of England, screened 12 778, and randomized 1764 into a suite of type 2 diabetes prevention and screen detected type 2 diabetes management trials. A key element of the program tested the value of volunteers with type 2 diabetes, trained to act as diabetes prevention mentors (DPM) when added to an intervention arm delivered by healthcare professionals trained to support participant lifestyle change.

RESULTS

We invited 9951 people with type 2 diabetes to become DPM and 427 responded (4.3%). Of these, 356 (83.3%) were interviewed by phone, and of these 131 (36.8%) were interviewed in person. We then appointed 104 of these 131 interviewed applicants (79%) to the role (mean age 62 years, 55% (n=57) male). All DPMs volunteered for a total of 2895 months, and made 6879 telephone calls to 461 randomized participants. Seventy-six (73%) DPMs volunteered for at least 6 months and 66 (73%) for at least 1 year.

DISCUSSION

Individuals with type 2 diabetes can be recruited, trained and retained as DPM in large numbers to support a group-based diabetes prevention program delivered by healthcare professionals. This volunteer model is low cost, and accesses the large type 2 diabetes population that shares a lifestyle experience with the target population. This is an attractive model for supporting diabetes prevention efforts.

The impact of a disease management programme for type 2 diabetes on health-related quality of life: multilevel analysis of a cluster-randomised controlled trial

BACKGROUND

Type 2 diabetes is a chronic disease associated with poorer health outcomes and decreased health related quality of life (HRQoL). The aim of this analysis was to explore the impact of a disease management programme (DMP) in type 2 diabetes on HRQoL. A multilevel model was used to explain the variation in EQ-VAS.

METHODS

A cluster-randomized controlled trial-analysis of the secondary endpoint HRQoL. Our study population were general practitioners and patients in the province of Salzburg. The DMP "Therapie-Aktiv" was implemented in the intervention group, and controls received usual care. Outcome measure was a change in EQ-VAS after 12 months. For comparison of rates, we used Fisher's Exact test; for continuous variables the independent T test or Welch test were used. In the multilevel modeling, we examined various models, continuously adding variables to explain the variation in the dependent variable, starting with an empty model, including only the random intercept. We analysed random effects parameters in order to disentangle variation of the final EQ-VAS.

RESULTS

The EQ-VAS significantly increased within the intervention group (mean difference 2.19, p = 0.005). There was no significant difference in EQ-VAS between groups (mean difference 1.00, p = 0.339). In the intervention group the improvement was more distinct in women (2.46, p = 0.036) compared to men (1.92, p = 0.063). In multilevel modeling, sex, age, family and work circumstances, any macrovascular diabetic complication, duration of diabetes, baseline body mass index and baseline EQ-VAS significantly influence final EQ-VAS, while DMP does not. The final model explains 28.9% (EQ-VAS) of the total variance. Most of the unexplained variance was found on patient-level (95%) and less on GP-level (5%).

CONCLUSION

DMP "Therapie-Aktiv" has no significant impact on final EQ-VAS. The impact of DMPs in type 2 diabetes on HRQoL is still unclear and future programmes should focus on patient specific needs and predictors in order to improve HRQoL.Trial registration Current Controlled trials Ltd., ISRCTN27414162.

Cost analysis of a peer support programme for patients with type 2 diabetes: a secondary analysis of a controlled trial

Background

This study aimed to explore if group-based peer support as an additional component to a disease management programme (DMP) in type 2 diabetes can reduce the number of prescribed drugs; hospital admissions; and length of hospital stay and therefore be a cost-effective model.

Methods

Controlled study based on a secondary data analysis of a cluster randomized trial. Our study population was general practitioners and patients in the province of Salzburg. The 24-months intervention consisted of regular group meetings facilitated by trained peer supporters. The groups exercised together, discussed diabetes related topics, and received support by professionals. Data was anonymously collected on clusters through the statutory health insurance.

Results

Data were available of 118 (82.5%,17 clusters of the patients in the original randomized trial) participants in the intervention and 143 (77.3%,19 clusters) in the control groups. The length of hospital stay was shorter in the intervention groups compared with controls. The mean difference during the 24-month study period was -40.13 days (95% CI - 78.54 to - 1.71, P = 0.041) in favour of the intervention groups. No differences were seen in the number of prescribed drugs and hospital admission. Estimated yearly savings by reducing the length of hospital stay was €1660.60 per patient.

Conclusion

A group-based peer support programme as an additional component of a DMP in type 2 diabetes is a promising approach to optimize diabetes care and to enhance lifestyle interventions in primary care. Peer support seems to reduce length of hospital stay and could therefore be a cost-effective model.

Diabetes self-management education reduces risk of all-cause mortality in type 2 diabetes patients: a systematic review and meta-analysis

BACKGROUND

Diabetes self-management education is an essential part of diabetes care, but its impact on all-cause mortality risk of type 2 diabetes patients is unclear. A systematic review and meta-analysis aiming to elucidate the impact of diabetes self-management education on all-cause mortality risk of type 2 diabetes patients was performed.

METHODS

Randomised controlled trials were identified though literature search in Medline, Embase, CENTRAL, conference abstracts, and reference lists. Only randomised controlled trials comparing diabetes self-management education with usual care in type 2 diabetes patients and reporting outcomes after a follow-up of at least 12 months were considered eligible. Risk ratios with 95 %CIs were pooled. This study was registered at PROSPERO with the number of CRD42016043911.

RESULTS

42 randomised controlled trials containing 13,017 participants were included. The mean time of follow-up was 1.5 years. There was no heterogeneity among those included studies (I ² = 0 %). Mortality occurred in 159 participants (2.3 %) in the diabetes self-management education group and in 187 (3.1 %) in the usual care group, and diabetes self-management education significantly reduced risk of all-cause mortality in type 2 diabetes patients (pooled risk ratios : 0.74, 95 %CI 0.60-0.90, P = 0.003; absolute risk difference: -0.8 %, 95 %CI -1.4 to -0.3). Both multidisciplinary team education and nurse-led education could significantly reduce mortality risk in type 2 diabetes patients, and the pooled risk ratios were 0.66 (95 %CI 0.46-0.96, P = 0.02; I ² = 0 %) and 0.64 (95 % CI 0.47- 0.88, P = 0.005; I ² = 0 %), respectively. Subgroup analyses of studies with longer duration of follow-up (≥1.5 years) or larger sample size (≥300) also found a significant effect of diabetes self-management education in reducing mortality risk among type 2 diabetes. Significant effect of diabetes self-management education in reducing mortality risk was also found in those patients receiving diabetes self-management education with contact hours more than 10 h (pooled risk ratio: 0.60, 95 %CI 0.44-0.82, P = 0.001; I ² = 0 %), those receiving repeated diabetes self-management education (pooled RR: 0.71, P = 0.001; I ² = 0 %), those receiving diabetes self-management education using structured curriculum (pooled risk ratio: 0.72, P = 0.01; I ² = 0 %) and those receiving diabetes self-management education using in-person communication (pooled risk ratio: 0.75, P = 0.02; I ² = 0 %). The quality of evidence for the effect of diabetes self-management education in reducing all-cause mortality risk among type 2 diabetes patients was rated as moderate according to the Grading of Recommendations Assessment, Development, and Evaluation method, and the absolute risk reduction of all-cause mortality of type 2 diabetic patients by diabetes self-management education was estimated to be 4 fewer per 1000 person-years (from 1 fewer to 6 fewer).

CONCLUSIONS

The available evidence suggests that diabetes self-management education can reduce all-cause mortality risk in type 2 diabetes patients. Further clinical trials with longer time of follow-up are needed to validate the finding above.

Impact of Disease Management Programs on HbA1c Values in Type 2 Diabetes Patients in Germany

BACKGROUND

The aim was to analyze the impact of disease management programs on HbA1c values in type 2 diabetes mellitus (T2DM) patients in Germany.

METHODS

This study included 9017 patients followed in disease management programs (DMPs) who started an antihyperglycemic treatment upon inclusion in a DMP. Standard care (SC) patients were included after individual matching (1:1) to DMP cases based on age, gender, physician (diabetologist versus nondiabetologist care), HbA1c values at baseline, and index year. The main outcome was the share of patients with HbA1c <7.5% or 6.5% after at least 6 months and less than 12 months of therapy in DMP and SC groups. Multivariate logistic regression models were fitted with HbA1c level as a dependent variable and the potential predictor (DMP versus SC).

RESULTS

The mean age was 64.3 years and 54.7% of the patients were men. The mean HbA1c level at baseline was equal to 8.7%. In diabetologist practices, 64.7% of DMP patients and 55.1% of SC patients had HbA1c levels <7.5%, while 23.4% of DMP patients and 16.9% of SC patients had HbA1c levels <6.5% ( P values < .001). By comparison, in general practices, 72.4% of DMP patients and 65.7% of SC patients had HbA1c levels <7.5%, while 29.0% of DMP patients and 25.4% of SC patients had HbA1c levels <6.5% ( P values < .001). DMPs increased the likelihood of HbA1c levels lower than 7.5% or 6.5% after 6 months of therapy in both diabetologist and general care practices.

CONCLUSION

The present study indicates that the enrollment of T2DM patients in DMPs has a positive impact on HbA1c values in Germany.

The Impact of Peer Support Program on Adherence to the Treatment Regimen in Patients with Hypertension: A Randomized Clinical Trial Study

Background:

High blood pressure is the greatest risk factor of death, and patients should manage to control it. Peer support program is used to control chronic diseases. This study aims to determine the effect of peer support program on adherence to the regimen in patients suffering from hypertension.

Materials and Methods:

This study is a clinical trial conducted among 64 patients with hypertension referring to the Hypertension Research Center (Isfahan. Iran). The information was collected in three stages – before the start of intervention, immediately after, and 1 month after the intervention using a questionnaire of adherence to the treatment regimen for high blood pressure. The questionnaires were filled using a questioning method by patients who were not aware of the study. The experimental group attended 6 sessions of the peer support program (1 hour), and the control group attended two sessions held by the researcher. Data were analyzed using the Statistical Package for the Social Sciences version 18 software, and statistical tests were analyzed using independent t-test and analysis of variance with repeated measures.

Results:

Before the intervention, there was no significant difference in adherence to the treatment regimen score between the two groups regarding the three aspects of medication regimen, diet, and activity program. Increase in scores of control group immediately after and 1 month after peer support program was higher (p < 0.001) compared to before the intervention.

Conclusions:

This study showed that peer support programs had a positive impact on adherence to the treatment regimen in patients suffering from hypertension.