Peer-Led, Empowerment-Based Approach to Self-Management Efforts in Diabetes (PLEASED): A Randomized Controlled Trial in an African American Community

Abstract

PURPOSE We compared a 3-month diabetes self-management education (DSME) program followed by a 12-month peer support intervention with a 3-month DSME program alone in terms of initial and sustained improvements in glycated hemoglobin (HbA 1c ). Secondary outcomes were risk factors for cardiovascular disease (CVD), diabetes distress, and social support. METHODSWe randomized 106 community-dwelling African American adults with type 2 diabetes to a 3-month DSME program followed by 12 months of weekly group sessions and supplementary telephone support delivered by peer leaders or to a 3-month DSME program with no follow-up peer support. Assessments were conducted at baseline, 3, 9, and 15 months. RESULTSNo changes in HbA 1c were observed at 3 months or at 15 months for either group. The peer support group either sustained improvement in key CVD risk factors or stayed the same while the control group worsened at 15 months. At 15 months, the peer-support group had significantly lower low-density lipoprotein cholesterol levels (-15 mg/dL, P = .03), systolic blood pressure (-10 mm Hg, P = .01), diastolic blood pressure (-8.3 mm Hg, P = .001), and body mass index (-0.8 kg/m 2 , P = .032) than the DSME-alone group.CONCLUSIONS In this population of African American adults, an initial DSME program, whether or not followed by 12 months of peer support, had no effect on glycemic control. Participants in the peer-support arm of the trial did, however, experience significant improvements in some CVD risk factors or stay approximately the same while the control group declined.

A Systematic Review: Family Support Integrated To Diabetes Self-Management among Glycemic Uncontrolled Type II DM Patients

“…We found that DSME based individual program was conducted into 40.9% of the studies (12,13,16,20,23,25,29,30,32) and 59.1% of the studies offered the DSME in a combination of individual and group education (12,14,15,17,20,21,27,31,32,34) . In general, The individual or group-based program provided the intervention of several strategies, including personalized counseling, feedback regarding goal-setting and problem-solving, support for self-care practice from family members, and the follow-up session.…”

“…Four studies used food model, picture, illustration, foot picture (14,18,20,24) . Diabetes handout/booklet (diet, exercise, medication, eye, and foot self-care) been used to spread the knowledge (15,16,19,21,30,32,36) . In addition, four studies (13,14,20,34) used video and DVD to show the successfully of self-care behaviors practice among diabetes patients.…”

“…This review verified that five studies follow-up the program by using a face-to-face follow-up (12,15,17,(22)(23)(24)33) . Three studies were noticed to follow-up the program by using the telephone method (13,14,25,26,32) . Mix of telephone and face-to-face follow-up strategies (18)(19)(20)29) and two studies did not mention about the follow-up process for evaluating the program (16,21) …”

“…(12,15,18,19,21,22,24,32,33) . In addition, several outcomes have a positive effect on psychosocial (35) , self-efficacy (14,24) , dietary and physical behavior aspects (19) , perceived support (15) , knowledge (32) , medication adherence and quality of life (32) . The improvement in several outcomes has clearly confirmed the importance of family involvement in diabetes self-management education.…”

“…Emotional distress associated with poor diabetes self-care and glycemic control which impacted to emotional responses, including feeling discouraged of diabetes treatment, worrying of long-term complications, and incorrectly defining the concrete of goals for diabetes cared (41) . From those existing studies, twelve studies addressed the psychological status as the intermediate outcomes, which reported that higher level of family support has a positive impact on reducing depressive symptoms (13,15,22,26) and positive emotional control (16) , psychosocial well-being (19,31,34) , quality of life (26,32) and diabetes related to distress and reducing barriers (17) . As the results, less depression has positive impacts on self-care behavior and certain clinical outcomes…”