Monika M Safford1, Susan Andreae2, Andrea L Cherrington2, Michelle Y Martin2, Jewell Halanych2, Marquita Lewis2, Ashruta Patel2, Ethel Johnson3, Debra Clark4, Christopher Gamboa2, Joshua S Richman5. 1. Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama msafford@uab.edu. 2. Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama. 3. Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama West Central Alabama Community Health Improvement League, Camden, Alabama. 4. Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama Sumter County Health and Wellness Education Center, Livingston, Alabama. 5. Birmingham VA Medical Center, Birmingham, Alabama Department of Surgery, University of Alabama at Birmingham and the Birmingham Veterans Affairs Medical Center, Birmingham, Alabama.
Abstract
PURPOSE: It is unclear whether peer coaching is effective in minority populations living with diabetes in hard-to-reach, under-resourced 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-randomized, controlled trial with primary care practices 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 settings; 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-resourced areas.
RCT Entities:
PURPOSE: It is unclear whether peer coaching is effective in minority populations living with diabetes in hard-to-reach, under-resourced 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-randomized, controlled trial with primary care practices 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 settings; 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-resourced areas.
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