Peer support for patients with type 2 diabetes: cluster randomised controlled trial

S M Smith, G Paul, A Kelly, D L Whitford, E O'Shea, T O'Dowd, S M Smith, G Paul, A Kelly, D L Whitford, E O'Shea, T O'Dowd

Abstract

Objective: To test the effectiveness of peer support for patients with type 2 diabetes.

Design: Cluster randomised controlled.

Setting: 20 general practices in the east of the Republic of Ireland.

Participants: 395 patients (192 in intervention group, 203 in control group) and 29 peer supporters with type 2 diabetes.

Intervention: All practices introduced a standardised diabetes care system. The peer support intervention ran over a two year period and contained four elements: the recruitment and training of peer supporters, nine group meetings led by peer supporters in participant's own general practice, and a retention plan for the peer supporters.

Main outcome measures: HbA(1c); cholesterol concentration; systolic blood pressure; and wellbeing score.

Results: There was no difference between intervention and control patients at baseline. All practices and 85% (337) of patients were followed up. At two year follow-up, there were no significant differences in HbA(1c) (mean difference -0.08%, 95% confidence interval -0.35% to 0.18%), systolic blood pressure (-3.9 mm Hg, -8.9 to 1.1 mm Hg), total cholesterol concentration (-0.03 mmol/L, -0.28 to 0.22 mmol/L), or wellbeing scores (-0.7, -2.3 to 0.8). While there was a trend towards decreases in the proportion of patients with poorly controlled risk factors at follow-up, particularly for systolic blood pressure (52% (87/166) >130 mm Hg in intervention v 61% (103/169) >130 mm Hg in control), these changes were not significant. The process evaluation indicated that the intervention was generally delivered as intended, though 18% (35) of patients in the intervention group never attended any group meetings.

Conclusions: A group based peer support intervention is feasible in general practice settings, but the intervention was not effective when targeted at all patients with type 2 diabetes. While there was a trend towards improvements of clinical outcomes, the results do not support the widespread adoption of peer support. Trial registration Current Controlled Trials ISRCTN42541690.

Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4788009/bin/smis804997.f1_default.jpg
Recruitment and follow-up of practices and participants. *Does not include participants lost to follow-up

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