https://immattersacp.org/weekly/archives/2010/10/19/6.htm

Peer support lowered A1cs in male veterans

Sibutramine pulled from the marketBisphosphonates to carry warning about femur fractures


A peer support program helped veterans with diabetes control their disease, a recent study found.

The randomized controlled trial included 244 men who had an A1c greater than 7.5% in the six months before the start of the study. They were randomized to receive either a nurse care management program, which entailed a 1.5 hour educational session, self-management materials and contact information for a nurse care manager, or reciprocal peer support. The peer support program included a similar educational session, but also additional training in peer communication skills. The participants in the peer-support group were matched with a peer of similar age and encouraged to talk weekly on the phone. They were also invited to optional group sessions at one, three and six months.

annals.jpg

After six months, the mean A1c of the peer-support group had decreased from 8.02% to 7.73%. The other group had an increase in A1c (from 7.93% to 8.22%) resulting in an overall change between groups of 0.58% (P=0.004). Patients who had an A1c of over 8% to start showed even greater improvement associated with the peer program. Those in the peer group had a decrease of 0.88% compared to a 0.07% decrease in the other group. The patients with peer support were also more likely to initiate insulin therapy (8 patients vs. 1 patient in the care management group). The results were published in the Oct. 19 Annals of Internal Medicine.

The decreases in A1c are similar to those achieved by most oral antiglycemic medications, the study authors noted, and peer-support programs are less resource-intensive than many interventions. The increase in insulin use in the peer-support group may indicate that patients' experiential concerns about insulin may be best addressed by another patient, the researchers speculated.

The study was limited by its length, relatively low uptake and inclusion of only male veterans in a similar age cohort who were likely to have common sense of identity. However, other research has shown peer-support interventions to be more acceptable to women than men. The model appears to be an effective and efficient means of allowing patients to help themselves and each other and therefore deserves further exploration as method of providing support for diabetes self-care, the study authors concluded. An accompanying editorial pointed out that the health care reform law has endorsed community support, including peer support programs, especially for medically underserved populations.