New Study Examines Peer Support System in Patients With Type 2 Diabetes Mellitus

Enduring an illness with a positive support system – either through friends or family – has often led many physicians to question the relationship between the physical and mental aspects of a patient’s recovery.

A new investigation published June 2 in JAMA Intern Medicine, led by Juliana Chan, MD, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, sought to learn whether frequent contacts through a telephone-based peer support program known as PEARL – Peer Support, Empowerment, and Remote Communication Linked by Information Technology – would improve cardiometabolic risk and health outcomes through psychological well-being and self-care in patients receiving integrated care implemented through a web-based multi-component quality improvement program called JADE – Joint Asia Diabetes Evaluation. However, this peer support did not improve cardiometabolic risks or psychological well-being.

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The investigators drew from 628 of 2,766 Hong Kong Chinese patients with type two diabetes mellitus from three publicly funded hospital-based diabetes centers between 2009 and 2010, and randomized them to the JADE (n=312) and PEARL (n=316) groups with comprehensive assessments at zero and 12 months, groups of 10 patients each were assigned to one of thirty-three peer supporters.

With a primary outcome to see change in HbA1c level and the secondary outcome the proportion of patients with attained goals (HbA1c <7.0 percent; blood pressure <130/80 mmHg; LDL-C level <2.6 mmol/L), results showed peer support did not improve cardiometabolic and psychological well-being in patients with type two diabetes mellitus receiving integrated care. In a six-month period, peer support reduced HbA1c levels by 0.77 compared with usual care in 300 patients with type two diabetes mellitus with a mean HbA1c level of 10 percent at baseline. In another six-month study involving 244 patients with diabetes, the mean HbA1c level fell from 8.02 percent to 7.73 percent in the peer support group and increased from 7.93 percent to 8.22 percent in the control group. In the present cohort with a mean HbA1c level of 8.2 percent, integrated care reduced HbA1c levels by 0.3 percent in both groups, with a 50 percent reduction in medication non-adherence rate, and eight to ten percent of patients actually had their treatments intensified.

The authors note that while an exploratory analysis showed that patients with negative emotions appeared to benefit from additional peer support with better treatment compliance, improved psychological health, and reduced hospitalizations, these interactions were not an outcome of their study. However, they add that their trial should be interpreted with caution, and "whether such peer support could benefit high-risk patients with emotional distress requires further study."

Keywords: Medication Adherence, Quality Improvement, Self Care, Diabetes Mellitus, Type 2, Telephone, Peer Group, Blood Pressure, Stress, Psychological, Patient Compliance

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