Peer Coaches to Improve Diabetes Outcomes in Rural Alabama: A Cluster Randomized Trial Effect of peer support on diabetes distress: a cluster randomized controlled trial Impact of Community Based Peer Support in Type 2 Diabetes: A Cluster Randomised Controlled Trial of Individual and/or Group Approaches Motivational interviewing delivered by diabetes educators: does it improve blood glucose control among poorly controlled type 2 diabetes patients? Comparative Effectiveness of Peer Leaders and Community Health Workers in Diabetes Self-management Support: Results of a Randomized Controlled Trial Spanish Diabetes Self-Management With and Without Automated Telephone Reinforcement Peer support to decrease diabetes-related distress in patients with type 2 diabetes mellitus: design of a randomised controlled trial The relative effectiveness of self-management programs for type 2 diabetes. Written emotional disclosure for adults with Type 2 diabetes: a primary care feasibility study. Diabetes Control With Reciprocal Peer Support Versus Nurse Care Management Effects of telephone-based peer support in patients with type 2 diabetes mellitus receiving integrated care: a randomized clinical trial. Type 2 diabetes patients educated by other patients perform at least as well as patients trained by professionals. Effectiveness of peer-led self-management coaching for patients recently diagnosed with Type 2 diabetes mellitus in primary care: a randomized controlled trial. Impact of Reinforcement of Diabetes Self-Care on Poorly Controlled Diabetes Who Can Provide Diabetes Self-Management Support in Primary Care? Telephone peer-delivered intervention for diabetes motivation and support: the telecare exploratory RCT.
PURPOSE It is unclear whether peer coaching is effective in minority population s living with diabetes in hard-to-reach , under-re source d areas such as the rural South . We examined the effect of an innovative peer-coaching intervention plus brief education vs brief education alone on diabetes outcomes . METHODS This was a community-engaged , cluster-r and omized , controlled trial with primary care practice s and their surrounding communities serving as clusters . The trial enrolled 424 participants , with 360 completing baseline and follow-up data collection ( 84.9 % retention ) . The primary outcomes were change in glycated hemoglobin ( HbA1c ) , systolic blood pressure ( BP ) , low density lipoprotein cholesterol ( LDL-C ) , body mass index ( BMI ) , and quality of life , with diabetes distress and patient activation as secondary outcomes . Peer coaches were trained for 2 days in community setting s ; the training emphasized motivational interviewing skills , diabetes basics , and goal setting . All participants received a 1-hour diabetes education class and a personalized diabetes report card at baseline . Intervention arm participants were also paired with peer coaches ; the protocol called for telephone interactions weekly for the first 8 weeks , then monthly for a total of 10 months . RESULTS Due to real-world constraints , follow-up was protracted , and intervention effects varied over time . The analysis that included the 68 % of participants followed up by 15 months showed only a significant increase in patient activation in the intervention group . The analysis that included all participants who eventually completed follow-up revealed that intervention arm participants had significant differences in changes in systolic BP ( P = .047 ) , BMI ( P = .02 ) , quality of life ( P = .003 ) , diabetes distress ( P = .004 ) , and patient activation ( P = .03 ) , but not in HbA1c ( P = .14 ) or LDL-C ( P = .97 ) . CONCLUSION Telephone-delivered peer coaching holds promise to improve health for individuals with diabetes living in under-re source d areas AIM To investigate whether peer support would reduce diabetes distress and improve glycaemic control when added to usual diabetes education among adults with Type 2 diabetes in China . METHODS We conducted a cluster r and omized trial involving 400 adults with Type 2 diabetes from eight communities in Nanjing . All participants received usual education for an average of 2 h each month from physicians , certified diabetes educators , dieticians , psychologists and podiatric nurses . Peer support was led by trained peer leaders and included diabetes knowledge- and skills-sharing at least once a month , as well as peer-to-peer communication . The primary outcome was diabetes distress measured using the Diabetes Distress Scale at 12 months . Secondary outcomes included fasting plasma glucose , 2-h postpr and ial glucose and HbA1c concentration . Outcome data were collected from all participants at baseline , 6 months and 12 months . RESULTS From 2012 to 2013 , there were 200 participants in each study arm at baseline . Compared with the usual education arm , the peer support with usual education arm had greater reductions in regimen-related distress ( 1.4 ± 0.6 vs 1.2 ± 0.4 ; P=0.004 ) and total distress ( 1.3 ± 0.4 vs 1.2 ± 0.3 ; P=0.038 ) at 6 months . At 12 months , the scores for emotional burden ( 1.2 ± 0.3 vs 1.4 ± 0.6 ; P=0.002 ) , physician-related distress ( 1.1 ± 0.3 vs 1.3 ± 0.4 ; P=0.001 ) and total scores ( 1.2 ± 0.3 vs 1.3 ± 0.4 ; P=0.002 ) were significantly lower in the peer support with usual education arm than in the usual education  arm . Fasting plasma glucose levels were lower in the peer support with usual education arm than in the usual education arm at 6 months ( 7.5 ± 1.95 vs 8.0 ± 2.2 ; P=0.044 ) and 12 months ( 7.0 ± 2.3 vs 7.6 ± 1.5 ; P=0.008 ) . CONCLUSIONS Beyond the benefits of usual education , peer support was effective in reducing diabetes distress for Type 2 diabetes mellitus . ( Clinical Trials Registry no : NCT02119572 ) BACKGROUND Diabetes peer support , where one person with diabetes helps guide and support others , has been proposed as a way to improve diabetes management . We have tested whether different diabetes peer support strategies can improve metabolic and /or psychological outcomes . METHODS People with type 2 diabetes ( n = 1,299 ) were invited to participate as either '  peer ' or ' peer support facilitator '  ( PSF ) in a 2x2 factorial r and omised cluster controlled trial across rural communities ( 130 clusters ) in Engl and .  Peer support was delivered over 8 - 12 months by trained PSFs , supported by monthly meetings with a diabetes educator . Primary end point was HbA1c . Secondary outcomes included quality of life , diabetes distress , blood pressure , waist , total cholesterol and weight . Outcome assessors and investigators were masked to arm allocation . Main factors were 1:1 or group intervention . Analysis was by intention-to-treat adjusting for baseline . RESULTS The 4 arms were well matched ( Group n = 330 , 1:1(individual ) n = 325 , combined n = 322 , control n = 322 ) ; 1035 ( 79·7 % ) completed the mid-point postal question naire and 1064 ( 81·9 % ) had a final HbA1c . A limitation was that although 92.6 % PSFs and peers were in telephone contact , only 61.4 % of intervention participants attended a face to face session . Mean baseline HbA1c was 57 mmol/mol ( 7·4 % ) , with no significant change across arms . Follow up systolic blood pressure was 2·3 mm Hg ( 0.6 to 4.0 ) lower among those allocated group peer-support and 3·0 mm Hg ( 1.1 to 5.0 ) lower if the group support was attended at least once . There was no impact on other outcomes by intention to treat or significant differences between arms in self-reported adherence or medication . CONCLUSIONS Group diabetes peer support over 8 - 12 months was associated with a small improvement in blood pressure but no other significant outcomes . Long term benefits should be investigated . TRIAL REGISTRATION IS RCT N.com IS RCT N6696362166963621 AIM To determine whether glycemic control is improved when motivational interviewing ( MI ) , a patient-centered behavior change strategy , is used with diabetes self management education ( DSME ) as compared to DSME alone . METHODS poorly controlled type 2 diabetes ( T2DM ) patients ( n=234 ) were r and omized into 4 groups : MI+DSME or DSME alone , with or without use of a computerized summary of patient self management barriers . We compared HbA1c changes between groups at 6 months and investigated mediators of HbA1c change . RESULTS study patients attended the majority of the four intervention visits ( mean 3.4 ) , but drop-out rate was high at follow-up research visits ( 35 % ) . Multiple regression showed that groups receiving MI had a mean change in HbA1c that was significantly lower ( less improved ) than those not receiving MI ( t=2.10 ; p=0.037 ) . Mediators of HbA1c change for the total group were diabetes self-care behaviors and diabetes distress ; no between-group differences were found . CONCLUSIONS DSME improved blood glucose control , underlining its benefit for T2DM management . However , MI+DSME was less effective than DSME alone . Overall , weak support was found for the clinical utility of MI in the management of T2DM delivered by diabetes educators 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 r and omized 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 . Assessment s 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 OBJECTIVE —To determine 1 ) whether participants in the Spanish Diabetes Self-Management Program ( SDSMP ) , when compared at 6 months to r and omized control subjects , would demonstrate improvements in health status , health behaviors , and self-efficacy ; and 2 ) whether SDSMP participants receiving monthly automated telephone reinforcement would maintain improvements at 18 months better than those not receiving reinforcement . RESEARCH DESIGN AND METHODS —A total of 567 Spanish-speaking adults with type 2 diabetes were r and omized to a usual-care control group or 6-week community-based , peer-led SDSMP . SDSMP participants were re-r and omized to receive 15 months of automated telephone messages or no reinforcement . A1C was measured at baseline and 6 and 18 months . All other data were collected by self-administered question naires . RESULTS —At 6 months SDSMP participants compared with control subjects demonstrated improvements in A1C ( −0.4 % ) , health distress , symptoms of hypo- and hyperglycemia , and self-efficacy ( P < 0.05 ) . At 18 months all improvements persisted ( P < 0.05 ) . SDSMP participants also demonstrated improvements in self-rated health and communication with physicians , had fewer emergency room visits ( −0.18 visits in 6 months , P < 0.05 ) , and trended toward fewer visits to physicians . At 18 months the only difference between reinforced and nonreinforced participants was increased glucose monitoring for the reinforcement group . CONCLUSIONS —The SDSMP  demonstrated effectiveness in lowering A1C and improving health status . Reinforcement did not add to its effectiveness . Given the high needs of the Spanish-speaking population , the SDSMP deserves consideration for implementation Background Many type 2 diabetes mellitus patients face difficulties self-managing their illness , which can lead to high levels of diabetes-related distress . Diabetes distress may be decreased by peer support , as peers underst and and have dealt with similar problems , and can help motivate each other . A recent systematic review concluded that evidence of benefits of peer support in patients with type 2 diabetes mellitus is too inconsistent due to weak theoretical foundation of the interventions . This study describes the design of a trial evaluating the effectiveness of a group-based , peer support programme with a strong theoretical foundation on diabetes-related distress in type 2 diabetes patients . Methods This is a parallel group r and omised controlled trial of a six session group-based peer support intervention , delivered by peer leaders and group psychotherapists , compared with one educational meeting on diabetes .  At least 152 patients with a type 2 diabetes duration of three years or more and between 50 and 70 years of age , recruited via their general practitioner , will be r and omised to receive the peer support intervention or one educational meeting . The intervention is developed in line with three key stages of research development of the Medical Research Council framework . The primary outcome measure for this study is diabetes-related distress . Secondary outcomes include self-management behaviour , well-being and health-related quality of life . Perceived social support is a process measure . Outcomes will be measured one month before , and 6 , and 12 months after the intervention by means of self-reported question naires . Analysis will be on an intention-to-treat basis . Discussion This article contains a description of the design of a study that will investigate the effect of a group-based , peer support intervention on diabetes-related distress in type 2 diabetes patients . The intervention was developed in recognition of the limited evidence , and the importance of a theoretical foundation and its implementation . Findings will contribute to knowledge in the field of peer support and patient-important outcomes in type 2 diabetes patients .Trial registration Dutch Trial Registry : OBJECTIVES The objectives of the study were to investigate the effectiveness of 2 types of peer-led self-management programs in bringing about improvements in subjects with type 2 diabetes mellitus and to determine whether there were differences in effectiveness between the 2 programs . METHODS The study used a 3-arm r and omized controlled trial design with clinical measures taken at baseline and at 6 and 12 months post-program . In total , 405 persons completed baseline question naires and were r and omly allocated to a diabetes self-management program ( n=130 ) , to a general self-management program ( n=109 ) or to a control group ( n=122 ) . A 2-way factorial analyses of variance was employed as the primary statistical analysis . RESULTS The findings showed that the self-management programs had affected 5 of the 30 measures : fatigue , cognitive symptom management , self-efficacy with regard to the disease in general , communication with physician , and the score on the Diabetes Empowerment Scale . In addition , 3 variables-social role limitations , total hospital nights and glycated hemoglobin levels-showed marginally significant interaction effects . The second analysis found similar results , with 4 of the 5 measures remaining statistically significant : fatigue , cognitive symptom management , communication with physician and diabetes empowerment , with neither program being more effective than the other . CONCLUSIONS The major findings are that although both programs were effective in bringing about positive changes in the outcome measures , there was little difference in effectiveness between the Diabetes Self-Management Program and the Chronic Disease Self-Management Program . This finding is consistent with the principle that behaviour-change strategies using self-efficacy are key components in health education programs AIM To test the feasibility of written emotional disclosure ( WED ) for UK primary care patients with Type 2 diabetes . BACKGROUND WED holds potential to address depressive symptoms in diabetes , yet its feasibility , and potential benefit , for primary care patients has not been established . METHOD Forty-one adults with Type 2 diabetes were r and omised to WED ( n=23 ) or neutral writing ( n=18 ) . Principal outcomes were feasibility of recruitment , compliance , acceptability and intervention fidelity . Potential benefit was assessed on between-group differences in depressive symptoms ( Centre for Epidemiological Studies Depression scale ) , diabetes distress ( Problem Areas in Diabetes scale ) , diabetes self-management behaviours ( Summary of Diabetes Self-care Activities question naire ) and perceived health status ( EQ-5D ) at three-month follow-up . FINDINGS Recruitment was modest ( 6 % ) , yet an unmet treatment need was identified . Fourteen intervention ( 61 % ) and 13(72 % ) control participants returned their writing , while 12 in each group ( 89 % ) then completed all sessions . Intervention fidelity was confirmed . Acceptability to patients was mixed . Exploratory effectiveness analyses suggested that relative to improvement in controls , WED is associated with a potentially clinical ly important worsening in depressive symptoms ( P=0.006 ) and a non-significant trend for a reduction in healthy dietary behaviour ( P=0.057 ) . There was no significant effect on other outcomes . The exploratory nature of the study , however , necessitates that the observed effects are interpreted with caution , and both the feasibility and effectiveness findings may be an artefact of the sample obtained . The evidence for the  feasibility of WED  in primary care diabetes was hence mixed , and in an unevaluated environment it may cause iatrogenic harm . On balance , WED is apparently not appropriate for use in this context in its current format . At most , further research with a more appropriate sample is required . The feasibility that was demonstrated and the unmet need identified suggest that this may be a worthy endeavour BACKGROUND Re source 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 R and omized , controlled trial . ( Clinical Trials.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 ) assessment s and 231 ( 95 % ) completed the survey assessment s 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 IMPORTANCE In type 2 diabetes mellitus ( T2DM ) , team management using protocol s with regular feedback improves clinical outcomes , although suboptimal self-management and psychological distress remain significant challenges . OBJECTIVE To investigate if frequent contacts through a telephone-based peer support program ( Peer Support , Empowerment , and Remote Communication Linked by Information Technology [ PEARL ] ) would improve cardiometabolic risk and health outcomes by enhancing psychological well-being and self-care in patients receiving integrated care implemented through a web-based multicomponent quality improvement program ( JADE [ Joint Asia Diabetes Evaluation ] ) . DESIGN , SETTING , AND PARTICIPANTS Between 2009 and 2010 , 628 of 2766 Hong Kong Chinese patients with T2DM from 3 publicly funded hospital-based diabetes centers were r and omized to the JADE + PEARL ( n = 312 ) or JADE ( n = 316 ) groups , with comprehensive assessment at 0 and 12 months . INTERVENTIONS Thirty-three motivated patients with well-controlled T2DM received 32 hours of training ( four 8-hour workshops ) to become peer supporters , with 10 patients assigned to each . Peer supporters called their peers at least 12 times , guided by a checklist . MAIN OUTCOMES AND MEASURES Changes in hemoglobin A(1c ) ( HbA(1c ) ) level ( primary ) , proportions of patients with attained treatment targets ( HbA(1c ) < 7 % ; blood pressure < 130/80 mm Hg ; low-density lipoprotein cholesterol < 2.6 mmol/L [ to convert to milligrams per deciliter , divide by 0.0256 ] ) ( secondary ) , and other health outcomes at month 12 . RESULTS Both groups had similar baseline characteristics ( mean [ SD ] age , 54.7 [ 9.3 ] years ; 57 % men ; disease duration , 9.4 [ 7.7 ] years ; HbA(1c ) level , 8.2 % [ 1.6 % ] ; systolic blood pressure , 136 [ 19 ] mm Hg ; low-density lipoprotein cholesterol level , 2.89 [ 0.82 ] mmol/L ; 17.4 % cardiovascular-renal complications ; and 34.9 % insulin treated ) . After a mean ( SD ) follow-up period of 414 ( 55 ) days , 5 patients had died , 144 had at least 1 hospitalization , and 586 had repeated comprehensive assessment s. On intention-to-treat analysis , both groups had similar reductions in HbA(1c ) ( JADE + PEARL , 0.30 % [ 95 % CI , 0.12%-0.47 % ] , vs JADE , 0.29 % [ 95 % CI , 0.12%-0.47 % ] [ P = .97 ] ) and improvements in treatment targets and psychological-behavioral measures . In the JADE + PEARL group , 90 % of patients maintained contacts with their peer supporters , with a median of 20 calls per patient . Most of the discussion items were related to self-management . CONCLUSIONS AND RELEVANCE In patients with T2DM receiving integrated care , peer support did not improve cardiometabolic risks or psychological well-being . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00950716 BACKGROUND Diabetes education can improve the quality of care of people with diabetes , but many organizations are not equipped to manage its implementation . Involving people with diabetes in the education process can overcome the problem . Thus , we compared clinical , metabolic and psychological outcomes in people with type 2 diabetes 1 year after attending a structured diabetes education programme implemented by professional educators versus the same programme implemented by trained peers with diabetes  that also provided ongoing peer support . METHODS People with type 2 diabetes ( 25 - 75 years ) were r and omly assigned to attend a 4-week structured diabetes education course delivered by professional educators ( control ) or previously trained peers ( peer ) . Peers also received continuing psychological support , including examples on how to apply diabetes knowledge in daily life via weekly peer cellular phone calls and bimonthly face-to-face interviews in small groups ( ten patients ) , using a structured question naire related to the patient 's clinical , metabolic and psychological progress . Identical outcome data from both groups were used for follow-up . RESULTS Both groups had a comparable positive effect on clinical , metabolic and psychological indicators immediately following the programme . Over the following year , peer-educated subjects had lower A(1C ) and systolic blood pressure and showed higher adherence to physical activity and better control of hypoglycaemic episodes . CONCLUSION The non-inferiority of the peer outcomes and the mentioned improvements in this group suggest that volunteer trained peer educators and ongoing support can be successful . This approach provides an effective alternative method of education , especially in areas with limited availability of professionals and economic re sources AIMS To study the effectiveness of a peer-led self-management coaching intervention in recently diagnosed patients with Type 2 diabetes . METHODS R and omized controlled trial of recently diagnosed patients with Type 2 diabetes from 54 participating general practice s. The intervention group received three home visits by an experienced peer ( expert patient ) who adhered to the recommended treatment and lifestyle guidelines . Together with their expert patient , participants set feasible goals and these were evaluated in the next visit . Participants in the control group received care as usual . At baseline , 3 months and 6 months post-intervention , participants completed a question naire measuring changes in self-efficacy , coping , physical activity , dietary habits , psychological well-being , depressive symptoms and diabetes related distress . RESULTS In total , 327 patients were eligible for inclusion in the study of which 133 consented to participate . In participating patients , self-efficacy , coping and saturated fat intake improved significantly over time . Analyses of participants with low self-efficacy at baseline ( 25th percentile : 44 ) revealed a significant time × group difference , F = 3.71 ; P = 0.03 . Participants who reported low psychological well-being at baseline increased substantially throughout the study ( F = 23.84 ; P < 0.01 ) but no significant time × group differences were found . CONCLUSIONS A peer-led self-management coaching programme for recently diagnosed patients with Type 2 diabetes  improved self-efficacy of patients experiencing low self-efficacy shortly after diagnosis Purpose The purpose of the study was to assess the value of reinforcing diabetes self-management for improving glycemia and self-care among adults with type 2 diabetes who had at least 3 hours of prior diabetes education . Methods In this r and omized controlled trial , 134 participants ( 75 % white , 51 % female , 59 ± 9 years old , 13 ± 8 years with diabetes , A1C = 8.4 % ± 1.2 % ) were r and omized  to either a group map-based program ( intervention ) or group education on cholesterol and blood pressure ( control ) . Participants were assessed for A1C levels , diabetes self-care behaviors ( 3-day pedometer readings , 6-minute walk test , blood glucose checks , frequency of self-care ) , and psychosocial factors ( distress , frustration , quality of life ) at baseline , 3 , 6 , and 12 months post intervention and health literacy at baseline . Results Groups did not differ on baseline characteristics including A1C levels , health literacy , or self-care ; however , the intervention group had more years of education than controls . Intervention arm participants modestly improved A1C levels at 3 months post intervention but did not maintain that improvement at 6 and 12 months while control patients did not improve A1C levels at any time during follow-up . Importantly , frequency of self-reported self-care , diabetes quality of life , diabetes-related distress , and frustration with diabetes self-care improved in both groups over time . Conclusions Reinforcing self-care with diabetes education for patients who have not met glycemic targets helps improve A1C and could be considered a necessary component of ongoing diabetes care . The best method to accomplish reinforcement needs to be established Purpose The purpose of this comparative effectiveness study is to compare diabetes self-management support ( DSMS ) approaches and determine who can be most effective in helping patients maintain/improve clinical  outcomes  ,  self-care behaviors , distress , and satisfaction following  diabetes self-management education ( DSME )  delivered in primary care . Methods After receiving DSME , 141 participants were r and omized to receive DSMS delivered by a trained supporter :  educator , peer , practice staff , or usual education during a 6-month follow-up period . DSMS groups were compared to determine which supporter helped participants to maintain/improve A1C , blood pressure , lipids , weight , self-care , and distress . DSMS satisfaction was also examined . Results There was a significant improvement in A1C , empowerment , aspects of self-care , and distress following DSME at 6 weeks . Those in the educator DSMS group best sustained improved A1C while those in the other DSMS groups maintained glycemic improvements but began to show trends toward worsening . No significant differences or clear trends were seen in other clinical , behavioral , or psychosocial outcomes . The Program Reinforcement Impacts Self-Management ( PRISM ) study demonstrates that following DSME , participants maintained improved glycemia , lipid , weight , and self-care behaviors and reductions in distress throughout the delivery of DSMS interventions regardless of DSMS supporter . All of the participants reported satisfaction with DSMS . Conclusions These findings reaffirm the critical role of educators but suggest that others may serve as DSMS supporters . Results suggest that DSME delivered in primary care is effective and multiple DSMS agents are reasonable . As patient-centered self-management approaches are being explored in primary care , delivery of DSME and DSMS becomes paramount OBJECTIVE To test trial design issues related to measuring the effectiveness of a peer telephone intervention to enhance self-efficacy in type 2 diabetes ; evaluate the impact on self-efficacy and clinical outcome ; and describe patient and peer experience . METHODS Eligible patients had raised HbA1c ( initial threshold > 8 % , reduced to > 7.4 % mid-way through trial ) . Patients were recruited from 40 general practice s and r and omised ( 40:40:20 ratio ) to receive routine care alone or , in addition ,  motivational telephone support from a peer supporter or a diabetes specialist nurse ( 9 peers and 12 DSNs ) for a period of up to 6 months . The primary outcome measure was self-efficacy score , and secondary outcome measures included HbA1c . Patient and telecare supporter satisfaction and experience were evaluated . RESULTS In all , 231 patients participated . At 6 months there were no statistically significant differences in self-efficacy scores ( p=0.68 ) , HbA1c ( p=0.87 ) or other secondary outcome measures . There was evidence of a high level of acceptability , but peer telecare support was less highly valued than that from a DSN . Some patients stated that they would have valued more information and advice . CONCLUSIONS Further consideration needs to be given to the targeting of the telecare peer support , its intensity , the training and ongoing supervision of peer supporters , and the extent to which information and advice should be incorporated . PRACTICE IMPLICATION S While some patients with poorly controlled type 2 diabetes value peer telephone support , this approach appears not to suit all patients . Further intervention development and evaluation is required before widespread adoption can be recommended
AIMS To assess the effect of peer support intervention on  diabetes distress in people with type 2 diabetes .
BACKGROUND Diabetes distress may be decreased by peer support intervention , but findings about the effect of peer support on diabetes distress have been mixed .