General practice, type 2 diabetes, cluster, randomised trial
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.
Community Health and Preventive Medicine | Medicine and Health Sciences | Public Health
Smith SM, Paul G, Kelly A, Whitford DL, O'Shea E, O'Dowd T. Peer support for patients with type 2 diabetes: cluster randomised controlled trial. British Medical Journal. 2011 Feb 15;342:d715.