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Defeat Diabetes
150 153rd Ave,
Suite 300

Madeira Beach, FL 33708

An Inexpensive, Effective Approach to Diabetes Management

Posted: Tuesday, December 28, 2010

Diabetes control with reciprocal peer support versus nurse care management.

This randomized trial compared the effects of a reciprocal peer support (RPS) program with nurse case management (NCM) in 244 US veterans with diabetes.

This study explored an interesting and novel approach to diabetes care by adding paired peer support to nurse care management. The findings were impressive, with an improvement in A1c similar to what might be expected from initiating therapy with an anti-hyperglycemic agent. However, the study was only 6 months in duration, and the frequency and duration of contact between peers decreased steadily from a mean of 2.4 calls per month with a 15.6-minute duration per call in the first month to 0.8 calls of 6.8 minutes' duration in the sixth month. Thus, whether the benefit would be maintained over longer follow-up is questionable.

Men were enrolled if they had A1c levels >7.5% in the previous 6 months. Men 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 patient (a peer). Peers were encouraged to talk weekly using a telephone platform that recorded call occurrence and provided reminders to promote peer contact. These men could also participate in optional group sessions at 1, 3, and 6 months. Men in the NCM group attended a 1.5-hour educational session and were assigned to a nurse care manager.

The primary outcome was 6-month change in A1c. Secondary outcomes were changes in insulin therapy; blood pressure; and patient reports of medication adherence, diabetes-related support, and emotional distress.

Mean A1c decreased from 8.02% to 7.73% in the RPS group and increased from 7.93% to 8.22% in the NCM group. The difference in A1c change between groups was 0.58% (P = .004). Among men with a baseline A1c 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 < .001). Eight men in the RPS group started insulin therapy, compared with 1 patient in the NCM group (P = .020). Groups did not differ in blood pressure, self-reported medication adherence, or diabetes-specific distress. However, the RPS group reported improvement in diabetes social support.

Still, it was somewhat surprising that the RPS program worked at all, given that the participants were exclusively men. Although the men shared the common bond of veteran status, it is still likely that women would be more receptive to contacting a peer and sharing their personal health issues. Thus, these results may represent the lower bound of what could be achieved with this type of program. In addition, although the absolute numbers were small, it is intriguing that 8 patients in the RPS group vs. 1 in NCM group initiated insulin therapy. Without qualitative analysis of the interactions, it is difficult to determine how peer support might have facilitated initiation of insulin therapy. It is possible that peer support could help men in particular, who are more reluctant to initiate such therapy.

In any case, RPS is an inexpensive and relatively easy program to establish, and it could provide many patients with the support they need to optimize their self-care.

Source:, Ann Intern Med. 2010;153:507-515, Stanford University School of Medicine

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