Effect of Peer Mentors in Diabetes Self-management vs Usual Care on Outcomes in US Veterans With Type 2 Diabetes: A Randomized Clinical Trial.

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  • Additional Information
    • Source:
      Publisher: American Medical Association Country of Publication: United States NLM ID: 101729235 Publication Model: Electronic Cited Medium: Internet ISSN: 2574-3805 (Electronic) Linking ISSN: 25743805 NLM ISO Abbreviation: JAMA Netw Open Subsets: MEDLINE
    • Publication Information:
      Original Publication: Chicago, IL : American Medical Association, [2018]-
    • Subject Terms:
      Peer Influence*; Diabetes Mellitus, Type 2/*therapy ; Mentors/*statistics & numerical data ; Self-Management/*methods ; Veterans/*psychology; Adult ; Aged ; Diabetes Mellitus, Type 2/psychology ; Female ; Glycated Hemoglobin/analysis ; Humans ; Male ; Middle Aged ; Self-Management/psychology ; Self-Management/statistics & numerical data ; United States ; Veterans/statistics & numerical data
    • Abstract:
      Importance: Diabetes is a substantial public health issue. Peer mentoring is a low-cost intervention for improving glycemic control in patients with diabetes. However, long-term effects of peer mentoring and creation of sustainable models are not well studied.
      Objective: Assess the effects of a peer support intervention for improving glycemic control in patients with diabetes and evaluate a model in which former mentees serve as mentors.
      Design, Setting, and Participants: A randomized clinical trial was conducted from September 27, 2012, to March 21, 2018, at the Corporal Michael J. Crescenz Medical Center. US veterans with type 2 diabetes aged 30 to 75 years with hemoglobin A1C (HbA1c) greater than 8% received support over 6 months from peers with prior poor glycemic control but who had achieved HbA1c less than or equal to 7.5% (phase 1). Phase 1 mentees were then randomized to become a mentor or not to new randomly assigned participants in phase 2. Outcomes were assessed at 6 and 12 months. Data were analyzed from October 5, 2016, to September 4, 2018.
      Interventions: Mentors who received an initial training session and monthly reinforcement training were assigned 1 mentee and given $20 for each month they contacted their mentee at least weekly.
      Main Outcomes and Measures: Primary outcome was HbA1c change at 6 months. Secondary outcomes included HbA1c change at 12 months and change in low-density lipoprotein, blood pressure, diabetes quality of life, and depression symptoms at 6 and 12 months.
      Results: The study enrolled 365 participants into phase 1 and 122 participants into phase 2. Most participants were Black (341 [66%]) and male (454 [96%]), with a mean (SD) age of 60 (7.5) years. Mean phase 1 HbA1c change at 6 months for usual care was -0.20% (95% CI, -0.46% to 0.06%) vs -0.52% (95% CI, -0.76% to -0.29%) for mentees (P = .06). Mean phase 2 HbA1c change at 6 months for usual care was -0.46% (95% CI, -1.02% to 0.10%) vs 0.08% (95% CI, -0.42% to 0.57%) for mentees (P = .16). There were no differences in secondary outcomes or HbA1c levels at 12 months. There was no benefit to past mentees who became mentors.
      Conclusions and Relevance: In this randomized clinical trial, a peer mentor intervention did not improve 6-month HbA1c levels and did not have sustained benefits.
      Trial Registration: ClinicalTrials.gov Identifier: NCT01651117.
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    • Grant Information:
      P30 DK092926 United States DK NIDDK NIH HHS
    • Molecular Sequence:
      ClinicalTrials.gov NCT01651117
    • Accession Number:
      0 (Glycated Hemoglobin A)
    • Publication Date:
      Date Created: 20200911 Date Completed: 20210108 Latest Revision: 20221207
    • Publication Date:
      20240628
    • Accession Number:
      PMC7489832
    • Accession Number:
      10.1001/jamanetworkopen.2020.16369
    • Accession Number:
      32915236