Peer Support for Diabetes Reduces Stress and Hospitalizations Among Highly Distressed
JAMA Intern Med. Published online April 28, 2014. [Abstract]
Effects of Telephone-Based Peer Support in Patients With Type 2 Diabetes Mellitus Receiving Integrated Care
Juliana C. N. Chan; Yi Sui; Brian Oldenburg; Yuying Zhang; Harriet H. Y. Chung; William Goggins; Shimen Au; Nicola Brown; Risa Ozaki; Rebecca Y. M. Wong; Gary T. C. Ko; Ed Fisher
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 randomized to the JADE + PEARL (n = 312) or JADE (n = 316) groups, with comprehensive assessment at 0 and 12 months.
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 A1c (HbA1c) level (primary), proportions of patients with attained treatment targets (HbA1c <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.
Both groups had similar baseline characteristics (mean [SD] age, 54.7 [9.3] years; 57% men; disease duration, 9.4 [7.7] years; HbA1c level, 8.2% [1.6%]; systolic blood pressure, 136  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 assessments. On intention-to-treat analysis, both groups had similar reductions in HbA1c (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.
With well organized care (JADE) that provides ample individualized feedback (eg, quarterly reports to patients) peer support may not be necessary for most folks, but that does improve emotional distress and eliminate disproportionate hospitalizations for the 20% distressed at baseline.