A peer support intervention in improving glycemic control in patients with type 2 diabetes

2018 ◽  
Vol 101 (3) ◽  
pp. 460-466 ◽  
Author(s):  
Maryam Peimani ◽  
Fateme Monjazebi ◽  
Robabeh Ghodssi-Ghassemabadi ◽  
Ensieh Nasli-Esfahani
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Peer Support ◽  
Support Intervention ◽  
Peer Support Intervention

scholarly journals Diabetes Distress and Glycemic Control in Type 2 Diabetes: Mediator and Moderator Analysis of a Peer Support Intervention (Preprint)

2020 ◽  
Author(s):  
Kara Mizokami-Stout ◽  
Hwajung Choi ◽  
Caroline R Richardson ◽  
Gretchen Piatt ◽  
Michele Heisler
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Peer Support ◽  
Goal Setting ◽  
Perceived Competence ◽  
Diabetes Distress ◽  
Support Intervention ◽  
Insulin Use ◽  
Peer Support Intervention

BACKGROUND High levels of psychosocial distress are correlated with worse glycemic control as measured by glycosylated hemoglobin levels (HbA<sub>1c</sub>). Some interventions specifically targeting diabetes distress have been shown to lead to lower HbA<sub>1c</sub> values, but the underlying mechanisms mediating this improvement are unknown. In addition, while type 2 diabetes mellitus (T2D) disproportionately affects low-income racial and ethnic minority populations, it is unclear whether interventions targeting distress are differentially effective depending on participants’ baseline characteristics. OBJECTIVE Our objective was to evaluate the mediators and moderators that would inform interventions for improvements in both glycemic control and diabetes distress. METHODS Our target population included 290 Veterans Affairs patients with T2D enrolled in a comparative effectiveness trial of peer support alone versus technology-enhanced peer support with primary and secondary outcomes including HbA<sub>1c</sub> and diabetes distress at 6 months. Participants in both arms had significant improvements in both HbA<sub>1c</sub> and diabetes distress at 6 months, so the arms were pooled for all analyses. Goal setting, perceived competence, intrinsic motivation, and decisional conflict were evaluated as possible mediators of improvements in both diabetes distress and HbA<sub>1c</sub>. Baseline patient characteristics evaluated as potential moderators included age, race, highest level of education attained, employment status, income, health literacy, duration of diabetes, insulin use, baseline HbA<sub>1c</sub>, diabetes-specific social support, and depression. RESULTS Among the primarily African American male veterans with T2D, the median age was 63 (SD 10.2) years with a baseline mean HbA<sub>1c</sub> of 9.1% (SD 1.7%). Improvements in diabetes distress were correlated with improvements in HbA<sub>1c</sub> in both bivariate and multivariable models adjusted for age, race, health literacy, duration of diabetes, and baseline HbA<sub>1c</sub>. Improved goal setting and perceived competence were found to mediate both the improvements in diabetes distress and in HbA<sub>1c</sub>, together accounting for 20% of the effect of diabetes distress on change in HbA<sub>1c</sub>. Race and insulin use were found to be significant moderators of improvements in diabetes distress and improved HbA<sub>1c</sub>. CONCLUSIONS Prior studies have demonstrated that some but not all interventions that improve diabetes distress can lead to improved glycemic control. This study found that both improved goal setting and perceived competence over the course of the peer support intervention mediated both improved diabetes distress and improved HbA<sub>1c</sub>. This suggests that future interventions targeting diabetes distress should also incorporate elements to increase goal setting and perceived competence. The intervention effect of improvements in diabetes distress on glycemic control in peer support may be more pronounced among White and insulin-dependent veterans. Additional research is needed to understand how to better target diabetes distress and glycemic control in other vulnerable populations.

scholarly journals "Peer Support" intervention to improve glycemic control in type 2 diabetes mellitus: A literature review

2021 ◽  
Vol 4 (2) ◽  
pp. 140
Author(s):  
Hasrima Hasrima ◽  
Elly Lilianty Sjattar ◽  
Andi Masyitha Irwan
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glycemic Control ◽  
Literature Review ◽  
Peer Support ◽  
Inclusion Criteria ◽  
Support Intervention ◽  
Peer Support Intervention

Hyperglycemia is one of the complications of Type 2 Diabetes Mellitus (T2DM). Continuation of this situation in T2DM will lead to more serious complications such as morbidity and death. There are improvements and advances in the management of T2DM at present, but they are accompanied by an increase in medical costs. To solve these problems, an organized approach is needed to control hyperglycemia through peer support interventions which are considered to be able to reduce treatment costs. Peer support may take advantage of the ability of diabetes patients to support each other in managing their daily lives, which is very useful as a step to promote the type of daily behavioral efforts needed to prevent disease progression. This study aimed to identify the effect of peer support intervention in improving glycemic control in patients with T2DM. This study was a literature review using seven databases including PubMed, ScienceDirect, ProQuest, Clinical Key, Cochrane, Ebsco, and DOAJ. Inclusion criteria were: articles published in the last 10 years, in full text and in English version. Five studies were reviewed that met the inclusion criteria. The results of this review showed the effectiveness of peer support in improving glycemic control in diabetes patients. Peer support significantly lowered HbA1c and also led to a significant reduction in fasting blood sugar. Peer support may reduce glycosylated blood hemoglobin levels, increase knowledge regarding insulin use and increase diabetes self-management skills, especially in patients who do not have literacy skills. In conclusion, peer support can be used as a non-pharmacological therapy to improve glycemic control in patients with T2DM.

scholarly journals Peer Support Intervention’s Impact on Glycemic Control Among Type 2 Diabetes Mellitus Patients

2021 ◽  
Vol 8 (4) ◽  
pp. 308
Author(s):  
Dita Hanna Febriani
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glycemic Control ◽  
Peer Support ◽  
Positive Impact ◽  
Inclusion Criteria ◽  
Support Intervention ◽  
Peer Support Intervention

<p><em>S</em><em>everal models have been developed to provide support for patient self-management to control their blood glucose</em><em>. Peer support intervention believed to bring positive impact on glycemic control in patient with type 2 diabetes mellitus. </em><em>The aim of this review was to identify the effect of several peer support interventions on glycemic control among adult with type 2 diabetes mellitus</em><em>.</em><em> </em><em>An integrative search was conducted in electronic databased Pub Med, CINALH, and Cochrane. The inclusion criteria of studies included were employed peer support intervention, randomized control trial in patient with type 2 diabetes mellitus, glycemic control as outcome, English language, published in last 10 years, and available in free full text. Seven studies met the inclusion criteria and included in the further analysis. Five studies reported peer support intervention found statistically significant to improve glycemic control through decreasing HbA1c level. Short term </em><em>peer support intervention provide potential benefit on glycemic control.</em><em></em></p>

scholarly journals Understanding the mechanisms generating outcomes in a Danish peer support intervention for socially vulnerable people with type 2-diabetes: a realist evaluation

2021 ◽  
Author(s):  
Stine Dandanell Garn ◽  
Charlotte Glümer ◽  
Sarah Fredsted Villadsen ◽  
Gritt Marie Hviid Malling ◽  
Ulla Christensen
Keyword(s):  
Type 2 Diabetes ◽  
Peer Support ◽  
Contextual Factors ◽  
Healthcare Services ◽  
Realist Evaluation ◽  
Self Management ◽  
Support Intervention ◽  
Vulnerable People ◽  
Peer Support Intervention

Abstract Background: Despite increasing use and positive effects of peer support interventions, little is known about how they produce outcomes. Thus, it is essential not only to measure outcomes, but also to identify the mechanisms by which they are generated. Using a realist evaluation approach, we aimed to identify the mechanisms generating outcomes in a Danish peer support intervention for socially vulnerable people with type 2-diabetes (peers). By investigating how the peers interacted in the intervention, we further examined how peers’ individual contextual factors facilitated or hindered the mechanisms in operation. Methods: We used a multi-method case-study design (n=9). Data included semi-structured interviews with four key groups of informants (peer, peer supporter, project manager and a diabetes nurse) for each case (n=25). Furthermore, we collected survey data from peers both before and after participation (n=9). The interview data were analysed using a systematic text condensation, and the Intervention-context-actor-mechanism-outcome framework was used to structure the analysis. Results: We identified two groups of mechanisms that improved diabetes self-management and the use of healthcare services (outcomes): ‘perceived needs and readiness’ and ‘encouragement and energy’. However, the mechanisms only generated the intended outcomes among peers with a stable occupation and financial situation, a relatively good health condition, and sufficient energy (all defined as contextual factors). Independent of these contextual factors, ‘experience of social and emotional support’ was identified as a mechanism within all peers that increased self-care awareness (defined as output). Dependent on whether the contextual factors facilitated or hindered the mechanisms to generate outcomes, we categorised the peers into those who achieved outcomes and those who did not. Conclusions: We identified two groups of mechanisms that improved the peers’ diabetes self-management and use of healthcare services. The mechanisms only generated the intended outcomes if peers’ individual contextual factors facilitated an active interaction with the elements of the intervention. However, independent of these contextual factors, a third group of mechanisms increased self-care awareness among all peers. We highlight the importance of contextual awareness of the target groups in the design and evaluation of peer support interventions for socially vulnerable people with type 2-diabetes. Trial registration : ClinicalTrials.gov, Retrospective Registration (01/20/2021), registration number NCT04722289, https://clinicaltrials.gov/ct2/show/NCT04722289?term=The+Together+on+Diabetes+Intervention+-+a+Realist+Evaluation%2C&draw=2&rank=1 Keywords: Complex Intervention, Realist evaluation, Mechanisms, Context, Peer support, Diabetes self-management, Healthcare services, Inequality

COST EFFECTIVENESS OF PEER SUPPORT FOR TYPE 2 DIABETES

2012 ◽  
Vol 28 (1) ◽  
pp. 3-11 ◽  
Author(s):  
Paddy Gillespie ◽  
Eamon O'Shea ◽  
Gillian Paul ◽  
Tom O'Dowd ◽  
Susan M. Smith
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
Peer Support ◽  
Diabetes Care ◽  
Cost Effective ◽  
Potential Cost ◽  
Support Intervention ◽  
Trial Analysis ◽  
Peer Support Intervention

Objectives: The aim of this study is to examine the cost-effectiveness of a group-based peer support intervention in general practice for patients with type 2 diabetes.Methods: Incremental cost utility analysis combining within trial and beyond trial components to compare the lifetime costs and benefits of alternative strategies: Control: standardized diabetes care; Intervention: group-based peer support in addition to standardized diabetes care. Within trial analysis was based on a cluster randomized controlled trial of 395 patients with type 2 diabetes in the east of Ireland. Beyond trial analysis was conducted using the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model. Uncertainty was explored using a range of sensitivity analyses and cost-effectiveness acceptability curves were generated.Results: Compared with the control strategy, the intervention was associated with an increase of 0.09 (95 percent confidence interval [CI], −0.05 to 0.25) in mean quality-adjusted life-years per patient and savings of €637.43 (95 percent CI, −2455.19 to 1125.45) in mean healthcare cost per patient and €623.39 (95 percent CI, −2507.98 to 1298.49) in mean total cost per patient respectively. The likelihood of the intervention being cost-effective was appreciably higher than 80 percent for a range of potential willingness-to-pay cost-effectiveness thresholds.Conclusions: Our results suggest that while a group-based peer support intervention shows a trend toward improved risk factor management, we found no significant differences in final cost or effectiveness endpoints between intervention and control. The probabilistic results suggest that the intervention was more cost-effective, with probability values of higher than 80 percent across a range of potential cost-effectiveness threshold values.

scholarly journals Understanding the mechanisms generating outcomes in a Danish peer support intervention for socially vulnerable people with type 2-diabetes: a realist evaluation

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Stine Dandanell Garn ◽  
Charlotte Glümer ◽  
Sarah Fredsted Villadsen ◽  
Gritt Marie Hviid Malling ◽  
Ulla Christensen
Keyword(s):  
Type 2 Diabetes ◽  
Peer Support ◽  
Contextual Factors ◽  
Healthcare Services ◽  
Realist Evaluation ◽  
Self Management ◽  
Support Intervention ◽  
Vulnerable People ◽  
Peer Support Intervention

Abstract Background Despite an increasing use and positive effects of peer support interventions, little is known about how the outcomes are produced. Thus, it is essential not only to measure outcomes, but also to identify the mechanisms by which they are generated. Using a realist evaluation approach, we aimed to identify the mechanisms generating outcomes in a Danish peer support intervention for socially vulnerable people with type 2-diabetes (peers). By investigating the participating peers’ interactions, we furthermore examined how their individual contextual factors either facilitated or hindered the mechanisms in operation. Methods We used a multi-method case-study design (n = 9). Data included semi-structured interviews with four key groups of informants (peer, peer supporter, project manager, and a diabetes nurse) for each case (n = 25). Furthermore, we collected survey data from peers both before and after participation (n = 9). The interview data were analysed using a systematic text condensation, and the Intervention-context-actor-mechanism-outcome framework was used to structure the analysis. Results We identified 2 groups of mechanisms that improved diabetes self-management and the use of healthcare services (outcomes): ‘perceived needs and readiness’ and ‘encouragement and energy’. However, the mechanisms only generated the intended outcomes among peers with a stable occupation and financial situation, a relatively good health condition, and sufficient energy (all defined as contextual factors). Independent of these contextual factors, ‘experience of social and emotional support’ was identified as a mechanism within all peers that increased self-care awareness (defined as output). Dependent on whether the contextual factors facilitated or hindered the mechanisms to generate outcomes, we categorised the peers into those who achieved outcomes and those who did not. Conclusions We identified two groups of mechanisms that improved the peers’ diabetes self-management and use of healthcare services. The mechanisms only generated the intended outcomes if peers’ individual contextual factors facilitated an active interaction with the elements of the intervention. However, independent of these contextual factors, a third group of mechanisms increased self-care awareness among all peers. We highlight the importance of contextual awareness of the target groups in the design and evaluation of peer support interventions for socially vulnerable people with type 2-diabetes. Trial registration ClinicalTrials.gov, Retrospective Registration (20 Jan 2021), registration number NCT04722289.

scholarly journals Understanding the Mechanisms Generating Outcomes in a Danish Peer support Intervention for Socially Vulnerable People with type 2-Diabetes: A Realist Evaluation

2021 ◽  
Author(s):  
Stine Dandanell Garn ◽  
Charlotte Glümer ◽  
Sarah Fredsted Villadsen ◽  
Gritt Marie Hviid Malling ◽  
Ulla Christensen
Keyword(s):  
Type 2 Diabetes ◽  
Peer Support ◽  
Contextual Factors ◽  
Healthcare Services ◽  
Realist Evaluation ◽  
Self Management ◽  
Support Intervention ◽  
Vulnerable People ◽  
Peer Support Intervention

Abstract Background: Despite increasing use and positive effects of peer support interventions, little is known about how they produce outcomes. Thus, it is essential not only to measure outcomes, but also to identify the mechanisms by which they are generated. Using a realist evaluation approach, we aimed to identify the mechanisms generating outcomes in a Danish peer support intervention for socially vulnerable people with type 2-diabetes (peers). By investigating how the peers interacted in the intervention, we further examined how peers’ individual contextual factors facilitated or hindered the mechanisms in operation.Methods: We used a multi-method case-study design (n=9). Data included semi-structured interviews with four key groups of informants (peer, peer supporter, project manager and a diabetes nurse) for each case (n=25). Furthermore, we collected survey data from peers both before and after participation (n=9). The interview data were analysed using a systematic text condensation, and the Intervention-context-actor-mechanism-outcome framework was used to structure the analysis.Results: We identified two groups of mechanisms that improved diabetes self-management and the use of healthcare services (outcomes): ‘perceived needs and readiness’ and ‘encouragement and energy’. However, the mechanisms only generated the intended outcomes among peers with a stable occupation and financial situation, a relatively good health condition, and sufficient energy (all defined as contextual factors). Independent of these contextual factors, ‘experience of social and emotional support’ was identified as a mechanism within all peers that increased self-care awareness (defined as output). Dependent on whether the contextual factors facilitated or hindered the mechanisms to generate outcomes, we categorised the peers into those who achieved outcomes and those who did not. Conclusions: We identified two groups of mechanisms that improved the peers’ diabetes self-management and use of healthcare services. The mechanisms only generated the intended outcomes if peers’ individual contextual factors facilitated an active interaction with the elements of the intervention. However, independent of these contextual factors, a third group of mechanisms increased self-care awareness among all peers. We highlight the importance of contextual awareness of the target groups in the design and evaluation of peer support interventions for socially vulnerable people with type 2-diabetes.Trial registration: ClinicalTrials.gov, Retrospective Registration (01/20/2021), registration number NCT04722289, https://clinicaltrials.gov/ct2/show/NCT04722289?term=The+Together+on+Diabetes+Intervention+-+a+Realist+Evaluation%2C&draw=2&rank=1

scholarly journals Diabetes Distress and Glycemic Control in Type 2 Diabetes: Mediator and Moderator Analysis of a Peer Support Intervention

JMIR Diabetes ◽  
10.2196/21400 ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. e21400
Author(s):  
Kara Mizokami-Stout ◽  
Hwajung Choi ◽  
Caroline R Richardson ◽  
Gretchen Piatt ◽  
Michele Heisler
Keyword(s):  
Glycemic Control ◽  
Peer Support ◽  
Goal Setting ◽  
Perceived Competence ◽  
Diabetes Distress ◽  
Baseline Hba1c ◽  
Support Intervention ◽  
Insulin Use ◽  
Peer Support Intervention

Background High levels of psychosocial distress are correlated with worse glycemic control as measured by glycosylated hemoglobin levels (HbA1c). Some interventions specifically targeting diabetes distress have been shown to lead to lower HbA1c values, but the underlying mechanisms mediating this improvement are unknown. In addition, while type 2 diabetes mellitus (T2D) disproportionately affects low-income racial and ethnic minority populations, it is unclear whether interventions targeting distress are differentially effective depending on participants’ baseline characteristics. Objective Our objective was to evaluate the mediators and moderators that would inform interventions for improvements in both glycemic control and diabetes distress. Methods Our target population included 290 Veterans Affairs patients with T2D enrolled in a comparative effectiveness trial of peer support alone versus technology-enhanced peer support with primary and secondary outcomes including HbA1c and diabetes distress at 6 months. Participants in both arms had significant improvements in both HbA1c and diabetes distress at 6 months, so the arms were pooled for all analyses. Goal setting, perceived competence, intrinsic motivation, and decisional conflict were evaluated as possible mediators of improvements in both diabetes distress and HbA1c. Baseline patient characteristics evaluated as potential moderators included age, race, highest level of education attained, employment status, income, health literacy, duration of diabetes, insulin use, baseline HbA1c, diabetes-specific social support, and depression. Results Among the primarily African American male veterans with T2D, the median age was 63 (SD 10.2) years with a baseline mean HbA1c of 9.1% (SD 1.7%). Improvements in diabetes distress were correlated with improvements in HbA1c in both bivariate and multivariable models adjusted for age, race, health literacy, duration of diabetes, and baseline HbA1c. Improved goal setting and perceived competence were found to mediate both the improvements in diabetes distress and in HbA1c, together accounting for 20% of the effect of diabetes distress on change in HbA1c. Race and insulin use were found to be significant moderators of improvements in diabetes distress and improved HbA1c. Conclusions Prior studies have demonstrated that some but not all interventions that improve diabetes distress can lead to improved glycemic control. This study found that both improved goal setting and perceived competence over the course of the peer support intervention mediated both improved diabetes distress and improved HbA1c. This suggests that future interventions targeting diabetes distress should also incorporate elements to increase goal setting and perceived competence. The intervention effect of improvements in diabetes distress on glycemic control in peer support may be more pronounced among White and insulin-dependent veterans. Additional research is needed to understand how to better target diabetes distress and glycemic control in other vulnerable populations.

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