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

Tang, Tricia S.; Funnell, Martha; Sinco, Brandy; Piatt, Gretchen; Palmisano, Gloria; Spencer, Michael S.; Kieffer, Edith C.; Heisler, Michele

doi:10.2337/dc13-2161

Cited by 188Diabetes Management and EducationMobile Health and mHealth ApplicationsDiabetes Management and Research

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

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Tang, Tricia S., Funnell, Martha, Sinco, Brandy, Piatt, Gretchen, Palmisano, Gloria, Spencer, Michael S., Kieffer, Edith C., Heisler, Michele·2014·Diabetes Care

DOI 10.2337/dc13-2161PMC PMC4030090

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Abstract

OBJECTIVE: To compare a peer leader (PL) versus a community health worker (CHW) telephone outreach intervention in sustaining improvements in HbA1c over 12 months after a 6-month diabetes self-management education (DSME) program. RESEARCH DESIGN AND METHODS: One hundred and sixteen Latino adults with type 2 diabetes were recruited from a federally qualified health center and randomized to (1) a 6-month DSME program followed by 12 months of weekly group sessions delivered by PLs with telephone outreach to those unable to attend or (2) a 6-month DSME program followed by 12 months of monthly telephone outreach delivered by CHWs. The primary outcome was HbA1c. Secondary outcomes were cardiovascular disease risk factors, diabetes distress, and diabetes social support. Assessments were conducted at baseline, 6, 12, and 18 months. RESULTS: After DSME, the PL group achieved a reduction in mean HbA1c (8.2-7.5% or 66-58 mmol/mol, P < 0.0001) that was maintained at 18 months (-0.6% or -6.6 mmol/mol from baseline [P = 0.009]). The CHW group also showed a reduction in HbA1c (7.8 vs. 7.3% or 62 vs. 56 mmol/mol, P = 0.0004) post-6 month DSME; however, it was attenuated at 18 months (-0.3% or -3.3 mmol/mol from baseline, within-group P = 0.234). Only the PL group maintained improvements achieved in blood pressure at 18 months. At the 18-month follow-up, both groups maintained improvements in waist circumference, diabetes support, and diabetes distress, with no significant differences between groups. CONCLUSIONS: Both low-cost maintenance programs led by either a PL or a CHW maintained improvements in key patient-reported diabetes outcomes, but the PL intervention may have additional benefit in sustaining clinical improvements beyond 12 months.

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Peer leaders can effectively provide education and support for lifestyle, as demonstrated in a study where 116 Latino adults with T2D were randomized to receive diabetes self-management education and either 12 months of weekly group sessions with peer leaders or 12 months of telephone outreach with health workers; both groups achieved significant HbA1c, blood pressure, and waist circumference
“Finally, peer leaders can effectively provide education and support for lifestyle.This was demonstrated in a study where 116 Latino adults with T2D were randomized to receive diabetes self-management education and either 12 months of weekly group sessions with peer leaders or 12 months of telephone outreach with health workers (87).Both groups achieved significant HbA 1c , blood pressure, and”
From The CardioMetabolic Health Alliance (2015) · cites this paper as [87]

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Background
Peer support to improve diabetes care: an implementation evaluation of the Australasian Peers for Progress Diabetes Program
On behalf of the Australasian Peers for Progress Diabetes Project Investigators, Aziz, Z., Riddell, M. A., Absetz, P., Brand, M., & Oldenburg, B. F. (2018) · BMC Public Health · doi:10.1186/s12889-018-5148-8 · Cited by 69 · see citing works
The “A to Z” of Managing Type 2 Diabetes in Culturally Diverse Populations
Caballero, A. E. (2018) · Frontiers in Endocrinology · doi:10.3389/fendo.2018.00479 · Cited by 71 · see citing works
How to achieve better effect of peer support among adults with type 2 diabetes: A meta-analysis of randomized clinical trials
Zhang, X., Yang, S., Sun, K., Fisher, E. B., & Sun, X. (2015) · Patient Education and Counseling · doi:10.1016/j.pec.2015.09.006 · Cited by 68 · see citing works
“Among the remaining 21 articles, 20 were included in our metaanalysis study [13–32].”
BackgroundMethodInfluential
How patient and community involvement in diabetes research influences health outcomes: A realist review
Harris, J., Haltbakk, J., Dunning, T. L., Austrheim, G., Kirkevold, M., Johnson, M., & Graue, M. (2019) · Health Expectations · doi:10.1111/hex.12935 · Cited by 61 · see citing works
Economics of Community Health Workers for Chronic Disease: Findings From Community Guide Systematic Reviews
Jacob, V., Chattopadhyay, S. K., Hopkins, D. P., Reynolds, J. A., Xiong, K. Z., JONES, C. D., Rodriguez, B. J., Proia, K. K., Pronk, N. P., Clymer, J. M., et al. (2019) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2018.10.009 · Cited by 59 · see citing works
Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association
Powers, M. A., Bardsley, J. K., Cypress, M., Funnell, M. M., Harms, D., Fischl, A. H., Hooks, B., Isaacs, D. M., Mandel, E. D., Maryniuk, M. D., et al. (2020) · Journal of the American Pharmacists Association · doi:10.1016/j.japh.2020.04.018 · Cited by 66 · see citing works
Effectiveness of peer led intervention in improvement of clinical outcomes among diabetes mellitus and hypertension patients—A systematic review and meta-analysis
Krishnamoorthy, Y., Sakthivel, M., Sarveswaran, G., & Eliyas, S. K. (2018) · Primary care diabetes · doi:10.1016/j.pcd.2018.11.007 · Cited by 54 · see citing works
Picture Good Health: A Church-Based Self-Management Intervention Among Latino Adults with Diabetes
Little Village Community Advisory Board, Baig, A. A., Benitez, A., Locklin, C. A., Gao, Y., Lee, S. M., Quinn, M. T., Solomon, M. C., Sánchez-Johnsen, L., Burnet, D. L., et al. (2015) · Journal of General Internal Medicine · doi:10.1007/s11606-015-3339-x · Cited by 53 · see citing works
Community health workers in diabetes care: A systematic review of randomized controlled trials.
Trump, L. J., & Mendenhall, T. J. (2017) · Families Systems & Health · doi:10.1037/fsh0000283 · Cited by 55 · see citing works
Exploration of Users’ Perspectives and Needs and Design of a Type 1 Diabetes Management Mobile App: Mixed-Methods Study
Zhang, Y., Li, X., Luo, S., Liu, C., Liu, F., & Zhou, Z. (2018) · JMIR mhealth and uhealth · doi:10.2196/11400 · Cited by 51 · see citing works
“Internet-based mentoring programs can increase the frequency of blood sugar monitoring [46], and studies have demonstrated that peer leaders can provide effective diabetes self-management support [47,48].”
Enabling Services Improve Access To Care, Preventive Services, And Satisfaction Among Health Center Patients
Yue, D., Pourat, N., Chen, X., Lu, C. M., Zhou, W., Daniel, M. G., Hoang, H., Sripipatana, A., & Ponce, N. A. (2019) · Health Affairs · doi:10.1377/hlthaff.2018.05228 · Cited by 47 · see citing works
Leveraging cues from person-generated health data for peer matching in online communities
Hartzler, A. L., Taylor, M. N., Park, A., Griffiths, T., Backonja, U., McDonald, D. W., Wahbeh, S., Brown, C. S., & Pratt, W. (2016) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocv175 · Cited by 46 · see citing works
Long-Term Outcomes in Patients with Morbid Obesity and Type 1 Diabetes Undergoing Bariatric Surgery
Vilarrasa, N., Rubio, M. Á., Miñambres, I., Flores, L., Caixàs, A., Ciudin, A., Bueno, M., García‐Luna, P. P., Ballesteros-Pomar, M. D., de Adana, M. R., et al. (2016) · Obesity Surgery · doi:10.1007/s11695-016-2390-y · Cited by 42 · see citing works
Integrating Community Health Workers Into Medical Homes
Rogers, E. A., Manser, S. T., Cleary, J., Joseph, A. M., Harwood, E. M., & Call, K. T. (2018) · The Annals of Family Medicine · doi:10.1370/afm.2171 · Cited by 42 · see citing works
Effect of peer support on diabetes distress: a cluster randomized controlled trial
Ju, C., Shi, R., Li, Y., Ye, X., Jia, M., Han, J., Yang, T., Lu, Q. R., Jin, H., Cai, X., et al. (2018) · Diabetic Medicine · doi:10.1111/dme.13625 · Cited by 41 · see citing works
Community Health Worker Training Curricula and Intervention Outcomes in African American and Latinx Communities: A Systematic Review
Adams, L. B., Richmond, J., Watson, S., Cené, C. W., Urrutia, R. P., Ataga, O., Dunlap, P., & Corbie-Smith, G. M. (2020) · Health Education & Behavior · doi:10.1177/1090198120959326 · Cited by 41 · see citing works
“Only two studies included in our review incorporated cultural competency training into their respective CHW curricula, which were both aimed at reducing health disparities in Latinx communities (Ford-Paz et al., 2015; Tang et al., 2014).”
BackgroundResult
Resilience in Vulnerable Populations With Type 2 Diabetes Mellitus and Hypertension: A Systematic Review and Meta-analysis
Pesantes, M. A., Lazo-Porras, M., Dabrh, A. M. A., Ávila-Ramírez, J. R., Torres, M. D. C. C., Villamonte, G., Sánchez-Perez, G. P., Málaga, G., Bernabé‐Ortiz, A., & Miranda, J. J. (2015) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2015.06.003 · Cited by 43 · see citing works
“…of motivation and 25 minutes of listening (emotional and social support, role modeling) Two 3-hour sessions of diabetes self-management Proportion who reduced at least 0.5% of HbA1c at 6 months Tang et al 2014 Type 2 Diabetes 24 weeks Diabetes self-management support (DSMS) through Peer Leaders.”
BackgroundMethodInfluential
Effectiveness of Technologically Enhanced Peer Support in Improving Glycemic Management Among Predominantly African American, Low-Income Adults With Diabetes
Heisler, M., Choi, H., Mase, R., Long, J. A., & Reeves, P. J. (2019) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721719844547 · Cited by 38 · see citing works
Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association
Powers, M. A., Bardsley, J. K., Cypress, M., Funnell, M. M., Harms, D., Fischl, A. H., Hooks, B., Isaacs, D. M., Mandel, E. D., Maryniuk, M. D., et al. (2021) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721720987936 · Cited by 39 · see citing works
Assessing quality of life in diabetes: II – Deconstructing measures into a simple framework
Tang, T. S., Yusuf, F. L. A., Polonsky, W. H., & Fisher, L. (2016) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2016.10.007 · Cited by 36 · see citing works
New directions for diabetes prevention and management in behavioral medicine
Stetson, B. A., Minges, K. E., & Richardson, C. R. (2016) · Journal of Behavioral Medicine · doi:10.1007/s10865-016-9802-2 · Cited by 36 · see citing works
“Community-based interventions, including peer supporters, have also been found to assist individuals in their diabetes self-management efforts (Heisler, 2007; Tang et al., 2014).”
Background
Minimally Disruptive Medicine for Patients with Diabetes
Serrano, V., Spencer‐Bonilla, G., Boehmer, K. R., & Montori, V. M. (2017) · Current Diabetes Reports · doi:10.1007/s11892-017-0935-7 · Cited by 35 · see citing works
Racial/Ethnic Discrimination and Diabetes-Related Outcomes Among Latinos with Type 2 Diabetes
LeBrón, A. M. W., Spencer, M. S., Kieffer, E. C., Sinco, B. R., & Palmisano, G. (2018) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-018-0710-0 · Cited by 34 · see citing works
Impact of a community‐based approach to patient engagement in rural, low‐income adults with type 2 diabetes
Glenn, L. E., Nichols, M. G., Enriquez, M., & Jenkins, C. M. (2019) · Public Health Nursing · doi:10.1111/phn.12693 · Cited by 34 · see citing works
“Greater reductions in HgA1C have resulted from exposure to more contact hours from CHW’s or peer advisors, otherwise known as the “dosage effect” (Lepard et al., 2015; Palmas, 2014; Samuel-Hodge et al., 2009; Tang et al., 2014).”
Background
Current Perspectives on Psychological Insulin Resistance: Primary Care Provider and Patient Views
Krall, J. S., Gabbay, R. A., Zickmund, S. L., Hamm, M., Williams, K. R., & Siminerio, L. M. (2014) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2014.0268 · Cited by 33 · see citing works
“Integrated systems with community partners like pharmacists 29 for patient education along with peers and community workers for ongoing support 23,30 also offer advantages, given recent recognition of community support.”
High Diabetes Distress Among Ethnic Minorities Is Not Explained by Metabolic, Cardiovascular, or Lifestyle Factors: Findings From the Dutch Diabetes Pearl Cohort
Özcan, B., Rutters, F., Snoek, F. J., Roosendaal, M., Sijbrands, E. J. G., Elders, P. J. M., Holleman, F., Pijl, H., Tack, C. J., Abbink, E. J., et al. (2018) · Diabetes Care · doi:10.2337/dc17-2181 · Cited by 32 · see citing works
The impact of peer coach-led type 2 diabetes mellitus interventions on glycaemic control and self-management outcomes: A systematic review and meta-analysis
Verma, I., Gopaldasani, V., Jain, V., Chauhan, S., Chawla, R., Verma, P. K., & Hosseinzadeh, H. (2022) · Primary care diabetes · doi:10.1016/j.pcd.2022.10.007 · Cited by 32 · see citing works
Development of a Community Health Worker–Delivered Cognitive Behavioral Training Intervention for Individuals With Diabetes and Chronic Pain
Andreae, S. J., Andreae, L. J., Cherrington, A., Lewis, M. W., Johnson, E., Clark, D., & Safford, M. M. (2018) · Family & Community Health · doi:10.1097/fch.0000000000000197 · Cited by 32 · see citing works
Cardiovascular risk outcome and program evaluation of a cluster randomised controlled trial of a community-based, lay peer led program for people with diabetes
the Australasian Peers for Progress Diabetes Project Investigators, Riddell, M. A., Dunbar, J., Absetz, P., Wolfe, R. S., Li, H., Brand, M., Aziz, Z., & Oldenburg, B. F. (2016) · BMC Public Health · doi:10.1186/s12889-016-3538-3 · Cited by 31 · see citing works
“Several of these have looked at glycated haemoglobin (HbA1c) as the outcome and a number have reported a reduction in HbA1c [7, 8, 18 – 20].”
Background
Integration and utilization of peer leaders for diabetes self-management support: Results from project SEED (Support, Education, and Evaluation in Diabetes)
Piatt, G. A., Rodgers, E. A., Xue, L., & Zgibor, J. C. (2018) · The Diabetes Educator · doi:10.1177/0145721718777855 · Cited by 29 · see citing works
Self-citation
Examining the Support Peer Supporters Provide Using Structural Equation Modeling: Nondirective and Directive Support in Diabetes Management
Kowitt, S. D., Ayala, G. X., Cherrington, A., Horton, L. A., Safford, M. M., Soto, S., Tang, T. S., & Fisher, E. B. (2017) · Annals of Behavioral Medicine · doi:10.1007/s12160-017-9904-2 · Cited by 31 · see citing works
Understanding the impact of five major determinants of health (genetics, biology, behavior, psychology, society/environment) on type 2 diabetes in U.S. Hispanic/Latino families: Mil Familias - a cohort study
Morales, J., GLANTZ, N. M., LAREZ, A. J., Bevier, W. C., CONNEELY, M. M., Fan, L., Reed, B. L., Alatorre, C., Paczkowski, R., Ahmed, T., et al. (2020) · BMC Endocrine Disorders · doi:10.1186/s12902-019-0483-z · Cited by 30 · see citing works
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
Hernández, K. G. C., Laviada‐Molina, H., Hernandez-Escalante, V. M., Molina-Seguí, F., Mena-Macossay, L., & Caballero, A. E. (2020) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2020.08.107 · Cited by 30 · see citing works
Peer support interventions in type 2 diabetes: Review of components and process outcomes
Afshar, R., Tang, T. S., Askari, A. S., Sidhu, R., Brown, H., & Sherifali, D. (2020) · Journal of Diabetes · doi:10.1111/1753-0407.12999 · Cited by 29 · see citing works
“Eighteen studies defined eligibility criteria for PL recruitment.(11-20,22-25,27,29,30,32) Most studies required a personal history of diabetes as an eligibility criterion.”
BackgroundMethod
Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care and Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association
Powers, M. A., Bardsley, J. K., Cypress, M., Funnell, M. M., Harms, D., Fischl, A. H., Hooks, B., Isaacs, D. M., Mandel, E. D., Maryniuk, M. D., et al. (2020) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2020.04.020 · Cited by 32 · see citing works
Bariatric Surgery in Obese Patients with Type 1 Diabetes: Effects on Weight Loss and Metabolic Control
Faucher, P., Poitou, C., Carette, C., du Montcel, S. T., Barsamian, C., Touati, E.-B., Bouillot, J., Torcivia, A., Czernichow, S., Oppert, J., et al. (2016) · Obesity Surgery · doi:10.1007/s11695-016-2106-3 · Cited by 27 · see citing works
The impact of peer support program on adherence to the treatment regimen in patients with hypertension: A randomized clinical trial study
Moeini, M., haidari, A., & Khosravi, A. (2017) · Iranian Journal of Nursing and Midwifery Research · doi:10.4103/ijnmr.ijnmr_16_16 · Cited by 26 · see citing works
“[16] Johansson et al. (2014) conducted a study in Austria to investigate the effect of peer support group on metabolic values in patients with diabetes.”
Background
A randomized controlled trial of a community health worker intervention in a population of patients with multiple chronic diseases: Study design and protocol
Kangovi, S., Mitra, N., Turr, L., Huo, H., Grande, D., & Long, J. A. (2016) · Contemporary Clinical Trials · doi:10.1016/j.cct.2016.12.009 · Cited by 26 · see citing works
“Traditionally, public health researchers have tried to address this problem by using “universal outcome measures on which all diseases exert an effect” (such as self-rated health) [6], or else distal “hard” outcomes that are objective and easily measurable (such as mortality).”
Background
Understanding women veterans' preferences for peer support interventions to promote heart healthy behaviors: A qualitative study
Goldstein, K. M., Zullig, L. L., Oddone, E. Ž., Andrews, S. M., Grewe, M. E., Danus, S. M., Heisler, M., Bastian, L. A., & Voils, C. I. (2018) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2018.04.016 · Cited by 25 · see citing works
“very ill, depressed), models in which trained peers proactively reach out to participants would be more effective than mutual peer support models requiring participant initiative to contact their peer partner (Tang et al., 2014; Tang et al., 2011a; Tang et al., 2011b; Tang et al., 2015).”
Background
Feasibility and acceptability of a proposed trial of acupuncture as an adjunct to lifestyle interventions for weight loss in Polycystic Ovary Syndrome: a qualitative study
Ee, C., Smith, C. A., Costello, M., MacMillan, F., Moran, L., Baylock, B., & Teede, H. J. (2018) · BMC Complementary and Alternative Medicine · doi:10.1186/s12906-018-2358-7 · Cited by 25 · see citing works
Couple-based collaborative management model of type 2 diabetes mellitus for community-dwelling older adults in China: protocol for a hybrid type 1 randomized controlled trial
Liao, J., Wu, X., Wang, C., Xiao, X., Cai, Y., Wu, M., Liu, Y., Chen, X., Wu, S., Yang, Y. J., et al. (2020) · BMC Geriatrics · doi:10.1186/s12877-020-01528-5 · Cited by 25 · see citing works
Quality improvement strategies at primary care level to reduce inequalities in diabetes care: an equity-oriented systematic review
Terens, N., Vecchi, S., Bargagli, A. M., Agabiti, N., Mitrova, Z., Amato, L., & Davoli, M. (2018) · BMC Endocrine Disorders · doi:10.1186/s12902-018-0260-4 · Cited by 25 · see citing works
Can autonomy support have an effect on type 2 diabetes glycemic control? Results of a cluster randomized controlled trial
Yun, Q., Ji, Y., Liu, S., Shen, Y., Jiang, X., Fan, X., Liu, J., & Chang, C. (2020) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2019-001018 · Cited by 22 · see citing works
Peer-to-Peer Support and Changes in Health and Well-being in Older Adults Over Time
Schwei, R. J., Hetzel, S., Kim, K., Mahoney, J., DeYoung, K., Frumer, J., Lanzafame, R. P., Madlof, J., Simpson, A., Zambrano-Morales, E., et al. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.12441 · Cited by 23 · see citing works
Whole Health Action Management: A Randomized Controlled Trial of a Peer-Led Health Promotion Intervention
Cook, J. Α., Jonikas, J. A., Burke-Miller, J. K., Hamilton, M. M., Powell, I., Tucker, S. J., Wolfgang, J. B., Fricks, L., Weidenaar, J., Morris, E., et al. (2020) · Psychiatric Services · doi:10.1176/appi.ps.202000012 · Cited by 21 · see citing works
The value of peer support for self‐management of diabetes among veterans in the Empowering Patients In Chronic care intervention
Arney, J., Odom, E., Brown, C., Jones, L. A., Kamdar, N. P., Kiefer, L., Hundt, N. E., Gordon, H. S., Naik, A. D., & Woodard, L. (2019) · Diabetic Medicine · doi:10.1111/dme.14220 · Cited by 21 · see citing works
Diabetes Self-Care Behaviors Among Marshallese Adults Living in the United States
Felix, H. C., Rowland, B., Long, C. R., Narcisse, M., Piel, M., Goulden, P., & McElfish, P. A. (2017) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-017-0683-4 · Cited by 21 · see citing works
A Qualitative Exploration of Women’s Experiences with a Community Health Volunteer-Led Cervical Cancer Educational Module in Migori County, Kenya
Choi, Y., Oketch, S. Y., Adewumi, K., Bukusi, E. A., & Huchko, M. J. (2018) · Journal of Cancer Education · doi:10.1007/s13187-018-1437-2 · Cited by 19 · see citing works
Using Peer Support to Prevent Diabetes: Results of a Pragmatic RCT
Heisler, M., Dyer, W. T., Finertie, H., STOLL, S. C., Wiley, D. M., Turner, C. D., Sedgwick, T., Kullgren, J. T., Richardson, C. R., Hedderson, M. M., et al. (2023) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2023.02.015 · Cited by 19 · see citing works
Effectiveness of Diabetes Self-Management Education Programs for US Latinos at Improving Emotional Distress: A Systematic Review
Gutierrez, A. P., Fortmann, A. L., Savin, K. L., Clark, T. L., & Gallo, L. C. (2018) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721718819451 · Cited by 19 · see citing works
Effect of peer support intervention on diabetes distress in people with type 2 diabetes: A systematic review and meta‐analysis
Kong, L., Hu, P. F., Zhao, Q., Yao, H., & Chen, S. (2020) · International Journal of Nursing Practice · doi:10.1111/ijn.12830 · Cited by 17 · see citing works
The outcomes of peer-led diabetes education in comparison to education delivered by health professionals in Iranian patients
Ahmadi, Z., Sadeghi, T., & Loripoor, M. (2017) · Health Education Research · doi:10.1093/her/cyx068 · Cited by 17 · see citing works
Low empowerment and diabetes regimen distress are related to HbA1c in low income type 1 diabetes patients in a Brazilian tertiary public hospital
Silveira, M. S., Neto, A. M., Sposito, A. C., Siminerio, L. M., & Pavin, E. J. (2019) · Diabetology & Metabolic Syndrome · doi:10.1186/s13098-019-0404-3 · Cited by 17 · see citing works
Peer characteristics associated with improved glycemic control in a randomized controlled trial of a reciprocal peer support program for diabetes
Kaselitz, E. B., Shah, M. K., Choi, H., & Heisler, M. (2018) · Chronic Illness · doi:10.1177/1742395317753884 · Cited by 16 · see citing works
Determinants of self-management behaviors among pulmonary tuberculosis patients: a path analysis
Li, J., Pu, J., Liu, J., Wang, Q., Zhang, R., Zhang, T., Zhou, J., Xing, W., Liang, S., Hu, D., et al. (2021) · Infectious Diseases of Poverty · doi:10.1186/s40249-021-00888-3 · Cited by 16 · see citing works
Bridge to Health/Puente a la Salud: a pilot randomized trial to address diabetes self-management and social needs among high-risk patients
Fitzpatrick, S. L., Papajorgji‐Taylor, D., Schneider, J. L., Lindberg, N. M., Francisco, M. C., Smith, N. X., Vaughn, K., Vrany, E. A., & Hill‐Briggs, F. (2022) · Translational Behavioral Medicine · doi:10.1093/tbm/ibac016 · Cited by 15 · see citing works
US ethnic group differences in self-management in the 2nd diabetes attitudes, wishes and needs (DAWN2) study
Peyrot, M. F., Egede, L. E., Funnell, M. M., Hsu, W. C., Ruggiero, L., Siminerio, L. M., & Stuckey, H. L. (2018) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2018.03.002 · Cited by 15 · see citing works
Rethinking peer support for diabetes in Vancouver's South‐Asian community: a feasibility study
Tang, T. S., SOHAL, P. S., & Garg, A. (2014) · Diabetic Medicine · doi:10.1111/dme.12655 · Cited by 14 · see citing works
“While this method has been effective with other communities [19,35], participant-driven education requires that participants know what to ask.”
Method
Using Exploratory Focus Groups to Inform the Development of a Peer-Supported Pulmonary Rehabilitation Program
Poureslami, I. M., Camp, P. G., Shum, J., Afshar, R., Tang, T. S., & FitzGerald, J. M. (2016) · Journal of Cardiopulmonary Rehabilitation and Prevention · doi:10.1097/hcr.0000000000000213 · Cited by 14 · see citing works
Defining the Role of the Community Health Worker within a Federal Healthy Start Care Coordination Team
Raffo, J. E., Lloyd, C. S., Collier, M., Slater, L., Cunningham, B., Penninga, K., Henning, S., Coil, J., Agee, B. S., Quintino-Aranda, V., et al. (2017) · Maternal and Child Health Journal · doi:10.1007/s10995-017-2379-8 · Cited by 14 · see citing works
Lifestyle Interventions for People with, and at Risk of Type 2 Diabetes in Polynesian Communities: A Systematic Review and Meta-Analysis
Ndwiga, D. W., MacMillan, F., McBride, K. A., & Simmons, D. S. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15050882 · Cited by 14 · see citing works
Effect of peer support on health outcomes in patients with cardiac pacemaker implantation: A randomized, controlled trial
Shen, Z., Zheng, F., Zhong, Z., Ding, S., & Wang, L. (2019) · Nursing and Health Sciences · doi:10.1111/nhs.12595 · Cited by 14 · see citing works
Defining and measuring health equity in research on task shifting in high-income countries: A systematic review
Orkin, A. M., McArthur, A., Venugopal, J., Kithulegoda, N., Martiniuk, A. L. C., Buchman, D. Z., Kouyoumdjian, F. G., Rachlis, B., Strıke, C., & Upshur, R. E. G. (2019) · SSM - Population Health · doi:10.1016/j.ssmph.2019.100366 · Cited by 14 · see citing works
Diabetes Self-management Education and Support in Adults with Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care and Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association
Powers, M. A., Bardsley, J. K., Cypress, M., Funnell, M. M., Harms, D., Fischl, A. H., Hooks, B., Isaacs, D. M., Mandel, E. D., Maryniuk, M. D., et al. (2020) · Journal of the American Association of Nurse Practitioners · doi:10.1097/jxx.0000000000000473 · Cited by 13 · see citing works
Community Health Representative Workforce: Meeting the Moment in American Indian Health Equity
Sabo, S. J., O'Meara, L., Russell, K., Hemstreet, C., Nashio, J. T. N., Bender, B., Hamilton, J., & Begay, M. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.667926 · Cited by 13 · see citing works
Peer Support in Prevention, Chronic Disease Management, and Well-Being
Fisher, E. B., Bhushan, N. L., Coufal, M. M., Kowitt, S. D., Parada, H., Sokol, R. L., Tang, P. Y., Urlaub, D. M., & Graham, J. T. (2018) · Springer eBooks · doi:10.1007/978-0-387-93826-4_22 · Cited by 13 · see citing works
Acceptability of community health worker and peer supported interventions for ethnic minorities with type 2 diabetes: a qualitative systematic review
Grant, V., & Litchfield, I. J. (2024) · Frontiers in Clinical Diabetes and Healthcare · doi:10.3389/fcdhc.2024.1306199 · Cited by 12 · see citing works
Patient-Centered Medical Home Recognition and Diabetes Control Among Health Centers: Exploring the Role of Enabling Services
Dobbins, J. M., Peiper, N. C., Jones, E. B., Clayton, R., Peterson, L. E., & Phillips, R. L. (2017) · Population Health Management · doi:10.1089/pop.2017.0001 · Cited by 12 · see citing works
Beyond adherence to social prescriptions: How places, social acquaintances and stories help walking group members to thrive
Esmene, S., Leyshon, C., & Leyshon, M. (2020) · Health & Place · doi:10.1016/j.healthplace.2020.102394 · Cited by 12 · see citing works
An innovative model for management of cardiovascular disease risk factors in the low resource setting of Cambodia
Hernandez, N. N., Ismail, S., Heang, H., van Pelt, M. H., Witham, M. D., & Davies, J. I. (2020) · Health Policy and Planning · doi:10.1093/heapol/czaa176 · Cited by 12 · see citing works
“, 2013) and use of peers may improve care by reducing distances to accessing care, increasing patient knowledge and empowerment for improving behaviours to combat cardiovascular risk factors (Khetan et al., 2017; Brownson and Heisler, 2009; Tang et al., 2014).”
Background
From clinic to community: A randomized controlled trial of a peer support model for adults with type 2 diabetes from specialty care settings in British Columbia
Tang, T. S., Afshar, R., Elliott, T. G., Kong, J. M., & Gill, S. (2022) · Diabetic Medicine · doi:10.1111/dme.14931 · Cited by 12 · see citing works
The effect of peer-to-peer education on health literacy, knowledge, and adherence to COVID-19 protocols in vulnerable adolescents
Shoghli, A., Maleki, A., Masjedi, M. R., Hessari, M. B., & Khodaei, S. (2023) · BMC Family Practice · doi:10.1186/s12875-023-01979-w · Cited by 13 · see citing works
“Evidence shows that the use of peer-to-peer models to educate vulnerable populations has been successful, especially in some health aspects such as the prevention of communicable or non-communicable diseases [31, 32].”
Background
Establishing the Place of Health Social Work
Gehlert, S. J., Andrews, C. M., & Browne, T. A. (2019) · Health & Social Work · doi:10.1093/hsw/hlz011 · Cited by 11 · see citing works
Diabetes distress mediates the relationship between depressive symptoms and glycaemic control among adults with type 2 diabetes: Findings from a multi‐site diabetes peer support intervention
Qian, Y., Emmerling, D., Kowitt, S. D., Ayala, G. X., Cherrington, A., Heisler, M., Safford, M. M., Tang, T. S., Thom, D. H., & Fisher, E. B. (2023) · Diabetic Medicine · doi:10.1111/dme.15065 · Cited by 13 · see citing works

4Community Health and Social Services Center,
Mi, D. (2016)
Outcomes at 18 months from a community health worker and peer leader diabetes self-management program for Latino adults.
Spencer, M. S., Kieffer, E. C., Sinco, B., Piatt, G., Palmisano, G., Hawkins, J., Lebron, A., Espitia, N., Tang, T., Funnell, M., et al. (2018) · Diabetes Care · doi:10.2337/dc17-0978 · Cited by 153 · see citing works
Cost-Effectiveness of a Diabetes Self-Management Education and Support Intervention Led by Community Health Workers and Peer Leaders: Projections From the Racial and Ethnic Approaches to Community Health Detroit Trial
Ye, W., Kuo, S., Kieffer, E. C., Piatt, G., Sinco, B. R., Palmisano, G., Spencer, M. S., & Herman, W. H. (2020) · Diabetes Care · doi:10.2337/dc20-0307 · Cited by 30 · see citing works
Integration and utilization of peer leaders for diabetes self-management support: Results from project SEED (Support, Education, and Evaluation in Diabetes)
Piatt, G. A., Rodgers, E. A., Xue, L., & Zgibor, J. C. (2018) · The Diabetes Educator · doi:10.1177/0145721718777855 · Cited by 29 · see citing works
Peer-Led, Empowerment-Based Approach to Self-Management Efforts in Diabetes (PLEASED): A Randomized Controlled Trial in an African American Community
Tang, T. S., Funnell, M. M., Sinco, B. R., Spencer, M. S., & Heisler, M. (2015) · The Annals of Family Medicine · doi:10.1370/afm.1819 · Cited by 119 · see citing works

Authors: Tang, T. S., Funnell, M., Sinco, B., Piatt, G., Palmisano, G., Spencer, M. S., Kieffer, E. C., & Heisler, M.
Affiliations: University of British Columbia (CA)
University of Michigan (US)
Community Health and Social Services Center, Detroit, MI
Corresponding author: Tang, Tricia S.
ORCID: Tang, Tricia S.
Funnell, Martha
Piatt, Gretchen
Palmisano, Gloria
Spencer, Michael S.
Kieffer, Edith C.
Heisler, Michele
Venue: Diabetes Care
Publisher: American Diabetes Association
Published: 2014-05-10
Volume: 37
Issue: 6
Pages: 1525-1534
ISSN: 0149-5992 (ISSN-L)
1935-5548
DOI: 10.2337/dc13-2161
PMC: PMC4030090
OpenAlex: W2156742166
Cited by: 188
References: 42
Citations by year: 2026: 11 · 2025: 9 · 2024: 4 · 2023: 12 · 2022: 20 · 2021: 11 · 2020: 27 · 2019: 17 · 2018: 25 · 2017: 15 · 2016: 12 · 2015: 17 · 2014: 7
FWCI: 13.68
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc-nd
creativecommons.org/licenses/by-nc-nd/3.0/ (vor, 2667 d)
Locations: Diabetes Care (publishedVersion, cc-by-nc-nd)
Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
PubMed Central (publishedVersion, cc-by-nc-nd)
PubMed (publishedVersion)
Funders: U.S. Public Health Service (U50/CCU417409)
National Institute of Diabetes and Digestive and Kidney Diseases (R18DK0785501A1, P30DK092926)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords: peer leaders, community health workers, diabetes self-management education, type 2 diabetes, HbA1c, telephone outreach, Latino adults, diabetes distress, cardiovascular risk factors, blood pressure, waist circumference, federally qualified health centers
MeSH terms: Adult, Blood Pressure, Community Health Workers, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Glycated Hemoglobin, Humans, Male, Middle Aged, Patient Education as Topic, Peer Group, Quality of Life, Self Care, Social Support, Outcome Assessment, Health Care

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

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