WEDNESDAY, Oct. 20 (HealthDay News) -- Pairing people with
diabetes who are struggling to control their blood sugar levels
with their peers for weekly support sessions could be an effective
and inexpensive way to help manage the disease, researchers
Such a program was linked with significantly reduced blood sugar
levels in male veterans with diabetes, according to a new study
appearing in the Oct. 19 issue of the
Archives of Internal Medicine.
The authors initially identified almost 1,700 veterans who might
be eligible for the trial, but were only able to enroll 244. The
200-plus participants, all male, were randomized either to be
matched up with another diabetes patient for weekly peer support
and the option of attending group sessions, or to undergo one
educational training and then receive care from a nurse care
According to study author Dr. Michele Heisler, this model of
peer support is less hierarchical than most systems in the United
"We explicitly wanted to test whether patients who were having self-management challenges and ... [who] had dangerously high blood sugar levels over the prior three months ... might be better motivated themselves if given the opportunity to both help and receive help from another participant facing similar self-management challenges and who also had poor control," explained Heisler, who is a research scientist with the Center for Clinical Management Research at the Ann Arbor VA.
This appeared to be the case: Men in the peer-support group saw
a significant drop in their HbA1c levels (a measure of blood sugar
over time) -- from an average of 8.02 to 7.73 percent over six
months, which represented a 0.58 percent decrease from those in the
control group, who received care from a nurse.
"That is equivalent to adding a new oral anti-hyperglycemic medication and a very clinically significant difference," said Heisler, who is also associate professor of internal medicine and health behavior and health education at the University of Michigan Medical School.
Blood pressure dropped slightly (although not significantly) in
both groups, and no adverse effects were noted in either. Eight
patients in the peer group also started on insulin during the
trial, as opposed to just one in the control group, indicating that
peer support may also be instrumental in convincing often-resistant
patients to initiate insulin therapy, the authors stated.
Further study is needed to tease out which parts of a peer group
intervention are most successful, concluded the authors, who noted
that their research was limited in that it involved only men,
lasted just six months, and was not a double-blind study.
In addition to the weekly telephone calls, patients in the peer
group met about four-and-a-half hours more than those in the
control group, which probably accounted for at least some of the
improvement, said Dr. Joel Zonszein, director of the Clinical
Diabetes Center at Montefiore Medical Center in New York City.
"In diabetes, every time we spend more time with the patient - it could be a [nurse], a physician, or a Johnny-do-gooder, it reminds the patient to do something or to be more engaged," he said. "The outcomes short-term tend to be better."
Zonszein pointed out that almost 1,000 veterans contacted
declined to participate, a fact which he said may not bode well for
the success of this type of system in the real world.
However, he said, such programs may "play a role, especially in
minority populations where either language or ethnicity is very
different from our traditional American population. They really
help the bridging between health-care providers."
Peer educators may "almost be better suited for [certain]
important ingredients of diabetes self-management," added Sharon
Movsas, a certified diabetes educator who, like Zonszein, is with
Montefiore Clinical Diabetes Center. "The patient needs to feel
empowered and confident... It's not so much knowing what to eat but
'how am I going to change my behavior?' That involves
problem-solving and goal-setting skills and the evidence shows that
... the person can relate better to a peer who might have more
similarities than a teacher in the front of the room."
For more on living with diabetes, visit the
American Diabetes Association.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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