Phone calls from peer mentors improved veterans' hemoglobin A1c levels

A peer mentoring program improved diabetic African-American veterans' hemoglobin A1c (HbA1c) levels more than financial incentives did, a recent study found.

The six-month randomized controlled trial included 118 African-American veterans age 50 to 70 years who had been treated at the Philadelphia Veterans Affairs Medical Center and had an HbA1c of 8% or higher. One-third of the group was assigned to usual care: notification of their HbA1cs and recommendations about HbA1c goals. The second group was offered a financial incentive: $100 if they reduced their HbA1c levels by 1% and $200 if they decreased them by 2% or hit the goal of 6.5%. The members of the final group were each assigned a mentor, another African-American veteran of similar age who had formerly had poor glycemic control but now had an HbA1c of 7.5% or less. The mentor was asked (and paid $20) to talk to the patient over the phone at least once per week.

After six months, HbA1c had decreased most in the peer mentoring group. Their average HbA1c dropped from 9.8% to 8.7%, a mean change of −1.07% (95% CI, −1.84% to −0.31%) compared to the control group (whose HbA1cs decreased only from 9.9% to 9.8%). The financial incentive group saw a non-significant drop in HbA1c, from 9.5% to 9.1%, or −0.45% compared to controls (CI, −1.23% to 0.32%). Researchers concluded that peer mentorship improved glucose control in this cohort of African-American veterans with diabetes. The results were published in the March 20 Annals of Internal Medicine.

The authors noted that the mentors and patients communicated most in the first month of the program, having an average of four calls between each pair, and their conversations dropped off to a mean of two calls in the sixth month. All communication was conducted over the phone, and both patients and mentors reported that they would have appreciated face-to-face introductions. Despite this, the program was effective and could be useful, particularly in rural or suburban settings where in-person group support is inconvenient, the authors suggested. They also noted that the program was very cost-effective compared to many other possible interventions.

However, further research would be needed to determine whether the program would be effective in a broader population, since the participants were likely to already have a culture of camaraderie from their shared experiences and background. The authors also proposed future experimentation with transitioning successful mentees into mentors, which could improve their own glucose control as well as their new mentees'.