Date: October 20, 2010
Heisler, M., S. Vijan, et al. (2010). "Diabetes control with reciprocal peer support versus nurse care management: a randomized trial." Ann Intern Med 153(8): 507-515.
BACKGROUND: Resource barriers complicate diabetes care management. Support from peers may help patients manage their diabetes. OBJECTIVE: To compare a reciprocal peer-support (RPS) program with nurse care management (NCM). DESIGN: Randomized, controlled trial. (ClinicalTrials.gov registration number: NCT00320112) SETTING: 2 U.S. Department of Veterans Affairs health care facilities. PATIENTS: 244 men with hemoglobin A(1c) (HbA(1c)) levels greater than 7.5% during the previous 6 months. MEASUREMENTS: The primary outcome was 6-month change in HbA(1c) level. Secondary outcomes were changes in insulin therapy; blood pressure; and patient reports of medication adherence, diabetes-related support, and emotional distress. INTERVENTION: Patients in the RPS group attended an initial group session to set diabetes-related behavioral goals, receive peer communication skills training, and be paired with another age-matched peer patient. Peers were encouraged to talk weekly using a telephone platform that recorded call occurrence and provided reminders to promote peer contact. These patients could also participate in optional group sessions at 1, 3, and 6 months. Patients in the NCM group attended a 1.5-hour educational session and were assigned to a nurse care manager. RESULTS: Of the 244 patients enrolled, 216 (89%) completed the HbA(1c) assessments and 231 (95%) completed the survey assessments at 6 months. Mean HbA(1c) level decreased from 8.02% to 7.73% (change, -0.29%) in the RPS group and increased from 7.93% to 8.22% (change, 0.29%) in the NCM group. The difference in HbA(1c) change between groups was 0.58% (P = 0.004). Among patients with a baseline HbA(1c) level greater than 8.0%, those in the RPS group had a mean decrease of 0.88%, compared with a 0.07% decrease among those in the NCM group (between-group difference, 0.81%; P < 0.001). Eight patients in the RPS group started insulin therapy, compared with 1 patient in the NCM group (P = 0.020). Groups did not differ in blood pressure, self-reported medication adherence, or diabetes-specific distress, but the RPS group reported improvement in diabetes social support. LIMITATION: The study included only male veterans and lasted only 6 months. CONCLUSION: Reciprocal peer support holds promise as a method for diabetes care management.