Accelerating Best Practices in Peer Support Around the World

Diabetes Education is Only the Start

Sarah Kowitt, MPH

Dr. Andrea Cherrington and a peer supporter from Birmingham, Alabama, highlight the peers’ work and the value they bring to diabetes education at AADE 2014.


This past week, I was in Orlando, FL for the American Association of Diabetes Educators (AADE) Conference. While the conference was geared towards diabetes education, I was glad to see several sessions that recognized the importance of support for diabetes self-management.

For instance, Marti Funnell, who gave a keynote lecture on one of the most important diabetes studies in the last decade—the DAWN study—stressed that while we may be doing a good job tackling clinical issues in diabetes care, psychosocial issues, such as emotional well-being and support are under-addressed. For example, while 73% of people with diabetes received regular clinical assessments like HbA1c measurements, only 32% reported that they were asked by members of their healthcare team in the past 12 months about being anxious or depressed.1 Most healthcare professionals (63%) even agreed that there is a major need for better availability of resources for the provision of psychosocial support.2

Peers for Progress sponsored a group of diabetes peer supporters to attend the AADE Conference, from two projects that we funded in Alabama and California. As I got to know them over of the course of the conference, I learned more about their perspectives within the context of diabetes education and support.

Peer Supporters As Extensions of Diabetes Educators

The peer supporters felt that they were able to reach patients in a way that was not possible for other medical providers in large part because they came from the same background as their clients. For instance, one peer supporter from California said, “In our area, it’s easier for us to come in and gain people’s trust because we are peers and we are equal to them. We don’t know more than them. Because we are just like them, they let us in.”

By reaching patients, peer supporters said that they made the work of diabetes educators easier because patients were more receptive and willing to participate in diabetes education classes. In fact, all of the peer supporters emphasized that their roles complemented that of diabetes educators, a sentiment that was echoed by diabetes educators themselves. As one diabetes educator put it, “Peer supporters are extensions of educators. A lot of us [diabetes educators] are being cut and when we have peer supporters reach out to patients, then that is an asset. It is so useful”.

Thinking about diabetes education and diabetes support as a continuum of care, it becomes easier to see how their work is connected and mutually beneficial. In the end, diabetes educators and peer supporters are two sides of the same coin, united in the service of persons living with diabetes.

Helping Peers Overcome Barriers at Work

Peer supporters were proud of their achievements in reaching and engaging patients, helping them lose weight, improving clinical outcomes such as HbA1c, and empowering patients to improve their lifestyles. However, they struggle with barriers in many areas of their work.

For instance, some peer supporters mentioned that they had trouble reaching their patients either because they lived in a rural area where transportation was difficult and expensive or because they didn’t want to use up patients’ telephone minutes. Peer supporters also mentioned that many of the patients they worked with were in denial, experienced stigma as a result of their diabetes, or believed myths about the condition. This made patients less likely to communicate with medical providers about their diabetes and reinforced why peer supporters were helpful. Simply put, “It’s hard work,” as one peer supporter stated. The only way we can make this work easier is to remove some of these barriers and focus on support for peer supporters.

Support Peers with More Resources

When asked how researchers and policy-makers can better support peer supporters, the resounding answer was: resources. Peer supporters mentioned that they needed 1) updated information and 2) funding. A lot of the materials used by the peer supporters were from previous projects and were outdated or unlikely to be used by patients, and they emphasized that better materials were needed. Interestingly, while diabetes educators talked about the need for support in caring for diabetes patients, peer supporters also need access to the latest educational materials. Creating more opportunities for dialogue between the diabetes education and peer support communities can ensure that the needs of both groups are being met. Finally, peer supporters stressed the value of funding, not necessarily for themselves, but rather for reaching and better supporting their patients.

Refresh, Recharge, Renew

The theme of this year’s AADE conference was “Refresh, Recharge, Renew”, tapping into the need to take a step back every once in a while and remind ourselves about the important things in life so our fuel tanks aren’t running on empty.

The future of diabetes care will need the best efforts of those working in diabetes education and diabetes support. We hope that bringing more peer supporters into diabetes care will refresh the way that we approach diabetes education and renew our passion for this important work.



  1. Nicolucci, A., Kovacs Burns, K., Holt, R. I. G., Comaschi, M., Hermanns, N., Ishii, H., … & Peyrot, M. (2013). Diabetes Attitudes, Wishes and Needs second study (DAWN2™): Cross‐national benchmarking of diabetes‐related psychosocial outcomes for people with diabetes. Diabetic Medicine, 30(7), 767-777.
  2. Holt, R. I. G., Nicolucci, A., Kovacs Burns, K., Escalante, M., Forbes, A., Hermanns, N., … & Peyrot, M. (2013). Diabetes Attitudes, Wishes and Needs second study (DAWN2™): Cross‐national comparisons on barriers and resources for optimal care—healthcare professional perspective. Diabetic Medicine, 30(7), 789-798.


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