Can peer educators influence healthy eating in people with diabetes? Results of a randomized controlled trial

Abstract

Aims To assess whether the Expert Patient Programme (EPP), adapted for people with Type 2 diabetes, can be used to promote healthy eating to improve glycaemic control.Methods Adults with Type 2 diabetes (n = 317) were randomized to receive either a diabetes-specific EPP (n = 162) or individual one-off appointments with a dietitian (control group) (n = 155). The diabetes-specific EPP followed the standard National Health Service programme although all participants in the group had diabetes only, rather than a mix of chronic conditions. Participants attended a group session for 2 h once per week for 6 weeks. In addition, a final seventh-week 2-h session was included that was specific to issues concerning diabetes. Outcomes were assessed at baseline, 6 and 12 months.Results There were no statistically significant differences between the control and the intervention group in any of the clinical outcomes measured. There was no significant difference between the groups in any dietary outcome. There was a higher starch intake in the EPP group, although this did not reach statistical significance (effect size for starch adjusted for baseline values 8.8 g; 95% CI )1.3 to 18.9). There was some loss of participants between baseline measurement and randomization, although this did not appear to have had an important impact on baseline balance.

A Review of Volunteer-Based Peer Support Interventions in Diabetes

“…10 In all but a few cases, the intervention was delivered by a single peer supporter. 3,5,10,14 None of the interventions appeared to involve other health care providers in the delivery of the peer-support component. However, all of the group-based interventions incorporated skills-development components such as goal setting, action-planning, and problem solving.…”

“…[3][4][5][6][7][8][9][10][11][12][13][14][33][34][35][36] The 12 interventions included seven RCTs, four studies using a pre-/postdesign, 6,8,10,13 and one study using nonrandomized allocation of intervention and comparison groups. 14 Intervention delivery Face-to-face, group-based programs.…”

“…Seven (58%) studies were face-to-face, group-based interventions. 3,5,6,[10][11][12]14 They ranged in length from six weekly 90-minute group discussions 3 to 46 weekly 90-minute group discussions. 10 In all but a few cases, the intervention was delivered by a single peer supporter.…”

“…During the past decade, there has been a proliferation of research examining the feasibility, acceptability, and health-related impact of peer support interventions in the context of diabetes care. [3][4][5][6][7][8][9][10][11][12][13][14] Based on a review of peer support interventions for patients with diabetes, Heisler 15,16 identified five models of peer support, including 1) face-to-face group self-management programs, 2) peer coaches or mentors, 3) community health workers (CHWs), 4) telephone-based peer support, and 5) Internet or e-mail-based peer support.…”

Peer Support Interventions for Adults With Diabetes: A Meta-Analysis of Hemoglobin A1c Outcomes

“…21,26,27,30,37 In contrast, the pooled effect size from the 7 studies with predominantly white, non-Hispanic participants showed no improvement in HbA 1c level with peer support interventions, with an SMD of -0.004 (95% CI, -0.153 to 0.144; P = .95; I 2 = 59.41%). 22,25,29,[31][32][33][34] The pooled effect in the subgroup of 3 studies with predominantly African American participants showed a similar effect size to that seen in the Hispanic subgroup but was not statistically significant, with an SMD of 0.25 (95% CI, -0.064 to 0.571; P = .11; I 2 = 58.60%). 23,24,28 The differences in effect sizes between ethnicity subgroups were statistically significant, with a between-group P value of .03.…”