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Diabetes Control With Reciprocal Peer Support Versus Nurse Care Management: A Randomized Trial
Open accessAbstract
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.
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“Additionally, there is growing evidence for the role of community health workers (71,72), as well as peer (71)(72)(73)(74)(75)(76) and lay leaders (77), in providing ongoing support.”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:Standards of Care in Diabetes—2023 (2023) · cites this paper as [73]
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Metadata
- Authors
- Heisler, M., Vijan, S., Makki, F., & Piette, J. D.
- Affiliations
- University of Michigan (US)
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2010-10-19
- Volume
- 153
- Issue
- 8
- Pages
- 507-515
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- PMC
- PMC4117390
- OpenAlex
- W2066345304
- Cited by
- 366
- References
- 53
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 8 · 2023: 15 · 2022: 22 · 2021: 34 · 2020: 30 · 2019: 23 · 2018: 33 · 2017: 24 · 2016: 26 · 2015: 28 · 2014: 29 · 2013: 30 · 2012: 28
- FWCI
- 18.97
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Annals of Internal Medicine
- Funders
- National Heart, Lung, and Blood Institute (R01HL085420)
- National Institute of Diabetes and Digestive and Kidney Diseases (P60DK020572, P30DK092926)
- National Center for Research Resources (UL1RR024986)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
- Keywords
- nursing care management, diabetes self-management, glycemic control, HbA1c, veterans, peer support, insulin therapy, medication adherence, emotional distress, blood pressure, behavioral objectives, resource barriers, diabetes education
- MeSH terms
- Blood Pressure, Diabetes Mellitus, Type 1, Glycated Hemoglobin, Humans, Insulin, Male, Motivation, Psychotherapy, Group, Social Support, Stress, Psychological, Telephone, Treatment Outcome, Self Efficacy, Medication Adherence
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