Effects of Providing Peer Support on Diabetes Management in People With Type 2 Diabetes

PURPOSE We examined the effects of participating in a train-the-trainer program and being a peer supporter on metabolic and cognitive/psychological/behavioral parameters in Chinese patients with type 2 diabetes. METHODS In response to our invitation, 79 patients with fair glycemic control (HbA(1c) < 8%) agreed to participate in a train-the-trainer program to become peer supporters. Of the 59 who completed the program successfully, 33 agreed to be peer supporters (agreed trainees) and were each assigned to support 10 patients for 1 year, with a voluntary extension period of 3 additional years, while 26 trainees declined to be supporters ( refused trainees). A group of 60 patients with fair glycemic control who did not attend the training program and were under usual care were selected as a comparison group. The primary outcome was the change in average HbA1c levels for the 3 groups from baseline to 6 months. RESULTS At 6 months, HbA1c was unchanged in the trainees (at baseline, 7.1 +/- 0.3%; at 6 months, 7.1 +/- 1.1%) but increased in the comparison group (at baseline, 7.1 +/- 0.5%; at 6 months, 7.3 +/- 1.1%. P = .02 for between-group comparison). Self-reported self-care activities including diet adherence and foot care improved in the trainees but not the comparison group. After 4 years, HbA1c remained stable among the agreed trainees (at baseline, 7.0 +/- 0.2%; at 4 years: 7.2 +/- 0.6%), compared with increases in the refused trainees (at baseline, 7.1 +/- 0.4%; at 4 years, 7.8 +/- 0.8%) and comparison group (at baseline, 7.1 +/- 0.5%; at 4 years, 8.1 +/- 0.6%. P = .001 for between-group comparison). CONCLUSIONS Patients with diabetes who engaged in providing ongoing peer support to other patients with diabetes improved their self-care while maintaining glycemic control over 4 years.