How to achieve better effect of peer support among adults with type 2 diabetes: A meta-analysis of randomized clinical trials

doi:10.1016/j.pec.2015.09.006

Patient Education and Counseling

Volume 99, Issue 2, February 2016, Pages 186-197

https://doi.org/10.1016/j.pec.2015.09.006 Get rights and content

Highlights

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We evaluated the general effect of peer support on glycemic control.
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Peer support provided by patients themselves or nonprofessionals had better effect.
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Peer support of Home-visit and Curriculum-combined-reinforcement had better effect.
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Duration of peer support with the best cost-effectiveness is >3 and ≤6 months.

Abstract

Objectives

To study the effects of peer support on glycemic control and examine effects of different providers and types of support, intervention duration and effect duration.

Introduction

Diabetes mellitus is a chronic disease with significant morbidity and mortality which may result in long-term damage, dysfunction, and failure of organs such as retinopathy with potential loss of vision, nephropathy leading to renal failure, diabetic gangrene, and cardiovascular and cerebrovascular disease [1]. Furthermore, the prevalence rate of diabetes is increasing in countries around the world and the mortality of diabetes is also high [2], [3], [4]. There are several types of diabetes including type 1 diabetes, type 2 diabetes, gestational diabetes and other specific diabetes types [5]. Among all the patients with diabetes, about 90–95% have type 2 diabetes which “encompasses individuals who have insulin resistance and usually have relative (rather than absolute) insulin deficiency” [1]. The main characteristic of type 2 diabetes (T2DM) is hyperglycemia so that among patients with T2DM, the incidence of complications is strongly associated with the previous hyperglycemia [6].

According to the results of trials, epidemiological analysis and meta-analysis, hyperglycemia commonly measured by glycated hemoglobin (HbA_1c) is significantly associated with the incidence of macro-vascular complications, the primary cause of death in patients with T2DM [7]. “Each 1% reduction in updated mean HbA1c was associated with reductions in risk of 21% for any end point related to diabetes, 21% for deaths related to diabetes, 14% for myocardial infarction, and 37% for microvascular complications” [6]. Therefore, glycemic control is an important part of the treatment for patients with T2DM.

Patients with T2DM who want to control blood glucose effectively should make on-going changes in their lifestyle including diet, exercise, medication management and monitoring clinical and metabolic parameters which require strong self-management and self-regulation skills [8]. Thus, patients with T2DM need not only diabetes self-management education but also diabetes self-management support which could help them implement and sustain key behaviors in order to control their blood glucose [9]. Peer support, a kind of ongoing support from nonprofessionals, may effectively provide ongoing self-management support and help patients with diabetes change and sustain these key behaviors [8], [10]. One approach to defining peer support [10] identified four key functions of effective peer support as (1) assistance in daily management, (2) social and emotional support, (3) linkage to clinical care and community resources, and (4) ongoing availability of support. A guide developed by the Victorian Department of Human Services in Australia proposed seven types of peer support: Have a chat, Support groups, Internet and email peer support, Peer-led groups or events, Individual peer coaches, Telephone-based peer support, Community workers and Service provider-led groups [11]. As to the effect of peer support on glycemic control, there have been many studies on the relation between peer support and glycemic control effect among patients with T2DM but the results of different trials have not been altogether consistent. Additionally, there is no guideline for the implementation of peer support. Therefore, the purpose of this review is to study the effects of peer support on glycemic control for patients with T2DM and to identify important characteristics among providers, types, intervention duration and effect duration through meta-analysis among relevant randomized control trials (RCTs).

Section snippets

Data sources and searches

We searched Pubmed, ScienceDirect and Web of science to identify articles related to our study from their beginning to November 3rd, 2014. According to relevant definitions of peer support and the seven types of peer support, keywords used in searching were “type 2 diabetes”, “T2DM”, “self-management”, “peer support”, “peer group”, “peer coach”, “peer education” and “community health worker”. We did not enclose the phrases used in searching in order to achieve a broad enough search scope. In

Study selection and study characteristics

The twenty articles in the review included a total of 4494 participants (Fig. 1). Table 1, Table 2 present the characteristics and HbA_1c results of each study. The number of participants of each study ranged from 46 [27] to 628 [17]. One study [27] only included female participants and one [26] only included male participants. All participants had type 2 diabetes in 16 studies [13], [14], [15], [17], [18], [19], [20], [22], [23], [24], [25], [27], [28], [30], [31], [32]. In the remaining 4

Discussion

Peer support interventions have significantly positive effect on glycemic control for patients with T2DM with pooled effect on HbA1c of −0.16% (95% CI −0.25 to −0.007) or −1.7 mmol/mol (P < 0.001) and acceptable heterogeneity among studies (I² = 49.5%). As mentioned in the Introduction, a 1% reduction in HbA1c has been associated with “reductions in risk of 21% for any end point related to diabetes, 21% for deaths related to diabetes, 14% for myocardial infarction, and 37% for microvascular

Conflict of interest

Edwin Fisher received compensation for the following activities: serving as a speaker, from Sanofi; as an advisory committee member, from Sanofi and Novo Nordisk.

Funding

Edwin Fisher was supported by Peers for Progress, a program of the American Academy of Family Physicians (AAFP) Foundation, and by contributions from the Eli Lilly and Company Foundation and the Bristol-Myers Squibb Foundation, and by a Gillings Innovation Laboratory award funded by the 2007 Gillings Gift to the Gillings School of Global Public Health at the University of North Carolina-Chapel Hill.

Author contribution

X.Z. was responsible for conception, design, study searching, study selection, data extraction, quality assessment, data analysis, interpretation of data and manuscript writing. S.Y. was engaged in study selection, data extraction and quality assessment. K.S. was responsible for study searching and interpretation of data. E.B.F. was engaged in discussion and revision of the manuscript. X.S., as the guarantor of this work, was responsible for conception, design and critical revision of the

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Learning to PERSEVERE: A pilot study of peer mentor support and caregiver education in Lewy body dementia
2023, Parkinsonism and Related Disorders
Lewy Body Disease (LBD) is the second most common neurodegenerative disorder. Despite high family caregiver strain and adverse patient and caregiver outcomes, few interventions exist for LBD family caregivers. Based on a successful peer mentoring pilot study in advanced Parkinson's Disease, we revised the curriculum of this peer-led educational intervention incorporating LBD caregiver input.
We assessed feasibility of a peer mentor-led educational intervention and its impact on LBD family caregivers’ knowledge, dementia attitudes, and mastery.
Using community-based participatory research, we refined a 16-week peer mentoring intervention and recruited caregivers online through national foundations. Experienced LBD caregiver mentors were trained and matched with newer caregiver mentees with whom they spoke weekly for 16 weeks, supported by the intervention curriculum. We measured intervention fidelity biweekly, program satisfaction, and change in LBD knowledge, dementia attitudes, and caregiving mastery before and after the 16-week intervention.
Thirty mentor-mentee pairs completed a median of 15 calls (range: 8–19; 424 total calls; median 45 min each). As satisfaction indicators, participants rated 95.3% of calls as useful, and at week 16, all participants indicated they would recommend the intervention to other caregivers. Mentees' knowledge and dementia attitudes improved by 13% (p < 0.05) and 7% (p < 0.001), respectively. Training improved mentors’ LBD knowledge by 32% (p < 0.0001) and dementia attitudes by 2.5% (p < 0.001). Neither mentor nor mentee mastery changed significantly (p = 0.36, respectively).
This LBD caregiver-designed and -led intervention was feasible, well-received, and effective in improving knowledge and dementia attitudes in both seasoned and newer caregivers.
https://clinicaltrials.gov/ct2/show/NCT04649164 ClinicalTrials.gov Identifier: NCT04649164; December 2, 2020.
Using Peer Support to Prevent Diabetes: Results of a Pragmatic RCT
2023, American Journal of Preventive Medicine
High-contact structured diabetes prevention programs are effective in lowering weight and HbA1cs, yet their intensity level can create barriers to participation. Peer support programs improve clinical outcomes among adults with Type 2 diabetes, but their effectiveness in diabetes prevention is unknown. This study examined whether a low-intensity peer support program improved outcomes more than enhanced usual care in a diverse population with prediabetes.
The intervention was tested in a pragmatic 2-arm RCT.
Participants were adults with prediabetes at three healthcare centers.
Participants randomized to the enhanced usual care arm received educational materials. Participants in the Using Peer Support to Aid in Prevention and Treatment in Prediabetes arm were matched with a peer supporter: another patient who had made healthy lifestyle changes and was trained in autonomy-supportive action planning. Peer supporters were instructed to provide weekly telephone support to their peers on specific action steps toward behavioral goals for 6 months, then monthly support for 6 months.
Changes in primary outcomes of weight and HbA1c and secondary outcomes of enrollment in formal diabetes prevention programs, self-reported diet, physical activity, health-specific social support, self-efficacy, motivation, and activation at 6 and 12 months were examined.
Data collection occurred from October 2018 to March 2022, with analyses completed in September 2022. Among 355 randomized patients, in intention-to-treat analyses, there were no between-group differences in HbA1c or weight changes at 6 and 12 months. Using Peer Support to Aid in Prevention and Treatment in Prediabetes participants were more likely to enroll in structured programs at 6 (AOR=2.45, p=0.009) and 12 (AOR=2.21, p=0.016) months and to report eating whole grains at 6 (4.49, p=0.026) and 12 (4.22, p=0.034) months. They reported greater improvements in perceived social support for diabetes prevention behaviors at 6 (6.39, p<0.001) and 12 (5.48, p<0.001) months, with no differences in other measures.
A stand-alone, low-intensity peer support program improved social support and participation in formal diabetes prevention programs but not weight or HbA1c. It will be important to examine whether peer support could effectively complement higher-intensity, structured diabetes prevention programs.
This trial is registered at ClinicalTrials.gov, NCT03689530. Full protocol available at https://clinicaltrials.gov/ct2/show/NCT03689530.
Lower education and immigrant background are associated with lower participation in a diabetes education program – Insights from adult patients in the Outcomes & Multi-morbidity In Type 2 diabetes cohort (OMIT)
2023, Patient Education and Counseling
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From our study, those from Europe, the Middle East, Africa, and Asia were less likely to complete a diabetes start course programme compared to the Norwegians, which could imply the need for more culturally-tailored DSMES that offer interpretation services. A peer support approach has shown to improve glycaemic control in people with T2DM [41,42]. Even though the diabetes start course programme already includes laypersons sharing experiences of living with T2DM [15], the use of peer support tailored to the diversity of cultural backgrounds should be further examined.
Diabetes educational programmes should be offered to patients with type 2 diabetes mellitus (T2DM). We assessed the proportion of diabetes educational program participation among adults with T2DM, and its associations with place of residence in Norway, education, and immigrant background.
We identified 28,128 diagnosed with T2DM (2008–2019) in the Outcomes & Multi-morbidity In Type 2 diabetes cohort. To examine associations between sociodemographic factors and participation in diabetes start courses (yes/no), we computed adjusted risk ratios (95% CI) using log-binomial regression.
Overall, 18% participated on the diabetes start course, but partaking differed by Norwegian counties (range:12–34%). Individuals with an immigrant background were 29% less likely to participate (RR 0.71, CI 0.65–0.79). Similarly, those with a lower educational level were 23% less likely to participate (RR 0.77, CI 0.72–0.83) than those with the highest education. The association between education and start course participation was not significant in the subgroup of immigrant individuals (RR 0.88 CI 0.70–1.12).
We found that diabetes start course participation was overall low, especially in individuals with low education and immigrant background.
More efforts are needed to promote diabetes start courses in patients with T2DM.
Type 2 diabetes peer support interventions as a complement to primary care settings in high-income nations: A scoping review
2022, Patient Education and Counseling
Citation Excerpt :
CC BY 4.0. The majority of included studies on face-to-face self-management programs provided a favorable effect on improving HbA1c [11,29–40]; diabetes knowledge [29,31,33,34,37,41,42]; self-efficacy [11,12,33,34–36,43]; physical activity [11,31,33,34,44]; healthy eating [11,33,34,37,44]; and perceived social support [11,29,33,34,37,45,46]. The overall results were mixed related to diabetes distress [11,33,34,38,43,47–50], and metabolic parameters such as blood pressure [11,31,33,34,41,51,52], cholesterol [11,31,33,34,41,51], and BMI/weight [11,31,33,34,39,41,51].
Inadequate social support make way for peer support initiatives to complement the health system delivery of diabetes self-management education programs for type 2 diabetes (T2D). This review synthesizes knowledge about T2D peer support in terms of their various models and impact, endorsement, and contextual information in high-income nations.
A scoping review was conducted on published and grey literature in four electronic bibliographic databases between January 2007 to December 2021.
76 records were included. Face-to-face self-management programs and telephone-based peer support seem the most promising modalities given the largest scientific coverage on T2D outcomes. Face-to-face self-management programs were the most preferred by ethnic minority groups. Unlike peer supporters, healthcare professionals had mixed views about T2D peer support interventions. Managers of peer support programs perceived cultural competency as a cornerstone for peer support implementation. Care must be taken in recruiting, training and retaining peer supporters for sustainable practice.
Various T2D peer support models lie at the interface between primary care and community-based settings.
Fostering the role of peer support beyond healthcare organizations should be encouraged to engage the hardly reached, and to leverage community support to complement the health system.
Peer Support Added to Diabetes Education Improves Metabolic Control and Quality of Life in Mayan Adults Living With Type 2 Diabetes: A Randomized Controlled Trial
2021, Canadian Journal of Diabetes
Yucatán, located in the southern region of Mexico, is the state with the country’s highest prevalence of uncontrolled diabetes. Because of its particular cultural and socioeconomic characteristics, the residents of Yucatán face unique health-care challenges. The objective of our study was to evaluate the effect of peer support added to a diabetes education program on glycemic control and diabetes-related quality of life when compared with a conventional diabetes education program in patients with type 2 diabetes in a Mayan community in Mexico.
In March 2015, a total of 58 participants with a previous diagnosis of type 2 diabetes who were recruited from community health centres in Komchén were randomly assigned in equal numbers to 1 of 2 groups: 1) a peer support and diabetes self-management education group (PSEG) or 2) a conventional diabetes self-management education-only group. The primary outcomes of interest were glycated hemoglobin (A1C) values and diabetes-related quality of life. The majority of subjects were bilingual (Mayan and Spanish speakers), female and middle aged, and had a low level of formal education and high baseline A1C (mean, 8.7%).
Whereas both groups showed significant improvements from baseline to study end in absolute levels of A1C, the PSEG group had a more pronounced clinical improvement, but no statistical improvement, in A1C compared with the conventional diabetes self-management education-only group. PSEG participants exhibited statistically significant improvement in diabetes-related quality of life at 8 months.
Our study demonstrates the benefits of peer-support education above and beyond the impact of diabetes self-management education on diabetes-related quality of life in an underserved Mayan community in Mexico.
Le Yucatán, qui est situé dans la région du sud du Mexique, est l’état où la prévalence du diabète non maîtrisé est la plus élevée du pays. En raison des caractéristiques culturelles et socioéconomiques du Yucatán, les résidents affrontent des difficultés particulières en matière de soins de santé. L’objectif de notre étude était d’évaluer l’effet de l’ajout de l’entraide entre pairs au programme d’éducation en diabète sur la régulation de la glycémie et la qualité de vie liée au diabète par rapport au programme d’éducation en diabète traditionnel des patients atteints du diabète de type 2 de la communauté maya du Mexique.
En mars 2015, un total de 58 participants qui avaient un diagnostic antérieur de diabète de type 2 ont été recrutés dans des centres de santé communautaire de Komchén et répartis de façon aléatoire en nombres égaux soit dans le 1er groupe ou dans le 2e groupe : 1) un groupe qui bénéficiait d’entraide entre pairs et d’éducation à la prise en charge autonome du diabète (GEPÉ); 2) un groupe qui bénéficiait seulement de l’éducation traditionnelle à la prise en charge autonome du diabète. Les principaux critères d’intérêt étaient les valeurs de l’hémoglobine glyquée (A1c) et la qualité de vie liée au diabète. La majorité des sujets étaient bilingues (locuteurs mayas et espagnols), de sexe féminin et d’âge moyen, et avaient un faible niveau d’éducation formelle et des valeurs initiales élevées de l’A1c (moyenne, 8,7 %).
Alors que les 2 groupes ont montré des améliorations significatives des concentrations de l’A1c entre le début et la fin de l’étude, le groupe GEPÉ a montré une amélioration clinique plus prononcée, mais aucune amélioration statistique de l’A1c par rapport au groupe qui bénéficiait seulement de l’éducation traditionnelle à la prise en charge autonome du diabète. Les participants du groupe GEPÉ ont montré une amélioration significative sur le plan statistique de la qualité de vie liée au diabète après 8 mois.
Dans l’étude, nous démontrons que les avantages de l’entraide entre pairs vont au-delà de l’incidence de l’éducation à la prise en charge autonome du diabète sur la qualité de vie liée au diabète dans une communauté maya mal desservie du Mexique.
The impact of lack of disease awareness on the experience of primary varicose veins
2019, Journal of Vascular Nursing
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Medical staff should inform patients of the importance of wearing compression stocks postoperatively. Reports continue to support and encourage the strategy of continuous long-term health-related behaviors in chronic diseases,36,37 thus creating an environment of social support, cooperation, and supervision for patients; adjusting patients’ self-behavior; and strengthening their ability for self-management. Peer education can help patients with chronic diseases better manage through mutual communication and encouragement between peers with the same characteristics and experience and target groups.38,39
Symptoms are often one of the main reasons for patients with chronic diseases to seek medical care. However, the symptoms experienced by patients with primary varicose veins are not serious until late in the course, hence rarely drawing enough attention. A deep understanding of disease awareness and experiences of patients is particularly important in disease management. The aim of this study was to describe the awareness and experience of patients with primary varicose veins. This study used a descriptive design with a qualitative approach. Semistructured interviews were conducted with 12 patients with primary varicose veins at a general central county hospital in China. Colaizzi's 7-step analysis was used to analyze the interview text. Participants reported their lack knowledge of the disease, including etiology, symptoms, and complications. Three themes emerged concerning the experiences: “preoperative emotional responses,” “lack of confidence in disease management,” and “the need for family and social support.” The findings suggested that the health care system in China needed to increase the awareness about the disease and pay more attention to the needs of patients, give better health education, and provide effective social support, so as to improve self-management among patients.

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Review articleHow to achieve better effect of peer support among adults with type 2 diabetes: A meta-analysis of randomized clinical trials

Highlights

Abstract

Objectives

Introduction

Section snippets

Data sources and searches

Study selection and study characteristics

Discussion

Conflict of interest

Funding

Author contribution

J. Epidemiol. Glob. Health

Diabetes Res. Clin. Pract.

Diabetes Res. Clin. Pract.

Patient Educ. Couns.

Diagnosis and classification of diabetes mellitus

Diabetes Care

Diabetes prevention and treatment strategies: are we doing enough?

Diabetes Care

Estimating diabetes prevalence in Turkey in 2025 with and without possible interventions to reduce obesity and smoking prevalence, using a modelling approach

Int. J. Public Health

Definition, classification and diagnosis of diabetes mellitus

Exp. Clin. Endocrinol. Diabetes

Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study

Br. Med. J.

Peer-based behavioural strategies to improve chronic disease self-management and clinical outcomes: evidence, logistics, evaluation considerations and needs for future research

Fam. Pract.

Standards Revision Task Force National standards for diabetes self-management education and support

Diabetes Care

Peer support for self-management of diabetes improved outcomes in international settings

Health Affair

Peer Support: A guide to how people with a disability and carers can help each other to make the most of their disability supports

Global Evidence for Peer Support: Humanizing Health Care Report from an International Conference

Comparative effectiveness of peer leaders and community health workers in diabetes self-management support: results of a randomized controlled trial

Diabetes Care

Mexican American trial of community health workers: a randomized controlled trial of a community health worker intervention for Mexican Americans with type 2 diabetes mellitus

Am. J. Public Health

Diabetes prevention in Hispanics: report from a randomized controlled trial

Prev. Chronic Dis.

Effects of telephone-based peer support in patients with Type 2 Diabetes mellitus receiving integrated care a randomized clinical trial

J. Am. Med. Assoc. Inter. Med.

Review article
How to achieve better effect of peer support among adults with type 2 diabetes: A meta-analysis of randomized clinical trials