Peer-Delivered Cognitive Behavioral Training to Improve Functioning in Patients With Diabetes: A Cluster-Randomized Trial

Abstract

PURPOSE Cognitive behavioral therapy (CBT)-based programs delivered by trained community members could improve functioning and pain in individuals who lack access to such programs. We tested the effectiveness of a peer-delivered diabetes self-management program integrating CBT principles in improving physical activity, functional status, pain, quality of life (QOL), and health outcomes in individuals with diabetes and chronic pain. METHODSIn this community-based, cluster-randomized controlled trial, intervention participants received a 3-month, peer-delivered, telephone-administered program. Attention control participants received a peer-delivered general health advice program. Outcomes were changes in functional status and pain (Western Ontario and McMaster Universities Osteoarthritis Index), QOL (Short Form 12), and physiologic measures (hemoglobin A 1c , systolic blood pressure, body mass index); physical activity was the explanatory outcome. RESULTSOf 195 participants with follow-up data, 80% were women, 96% African Americans, 74% had annual income <$20,000, and 64% had high school education or less. At follow-up, compared with controls, intervention participants had greater improvement in functional status (-10 ± 13 vs -5 ± 18, P = .002), pain (-10.5 ± 19 vs -4.8 ± 21, P = .01), and QOL (4.8 ± 8.8 vs 3.8 ± 8.8, P = .001). Physiologic measures did not change significantly in either group. At 3 months, a greater proportion of intervention than control participants reported no pain or did other forms of exercise when pain prevented them from walking for exercise. CONCLUSION This peer-delivered CBT-based intervention improved functioning, pain, QOL, and self-reported physical activity despite pain in individuals with diabetes and chronic pain. Trained community members can deliver effective CBTbased interventions in rural and under-resourced communities.

Peer Support Intervention Improves Pain‐Related Outcomes Among Rural Adults With Diabetes and Chronic Pain at 12‐Month Follow‐Up

“…We evaluated the effect of the CBT‐based peer support “Living Healthy” intervention on pain‐related outcomes among adults with diabetes and chronic pain, one of the first efforts combining CBT and peer support for chronic pain management. The intervention did not lead to change in A1c or BMI at 3‐month follow‐up, 29 but it did produce greater improvement in pain‐related self‐efficacy, pain intensity, and functioning, compared to the general health education group. Importantly, these results were sustained at 12‐month follow‐up after the intervention completion.…”

“…Peer advisors and participants were not blinded to the arm assignment for practical reasons. The primary trial outcomes included health‐related quality of life, functional status, glycated hemoglobin (A1c), systolic blood pressure (SBP), and body mass index 29 . The study was designed to provide 80% power to detect clinically important differences in A1c (0.4%) and SBP (4 mm Hg).…”

A Virtual Skills Centre on Behaviour Management in Chronic Disease for Lay People in Low- and Middle-Income Countries (LMICs)

“…In particular, in marginalised communities, it has been shown to foster wide benefits to civil society, economic and political engagement, and social development. 11-14…”

“…Therefore, this programme supports current studies that found lay people who have the skills to support diabetes patients, can improve self management behaviours, such as glucose levels, diet and exercise. 13-14 Thus, reducing complications and adverse outcomes for people with chronic conditions…”

“…costly to attend or have limited free time. 14-16 Our goal is to make a programme to address these two barriers. This will be through both a face-to-face and online virtual skills centre.…”