Mobile-Enhanced Peer Support for African Americans with Type 2 Diabetes: a Randomized Controlled Trial
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Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Cooper Green Mercy Health Services, Birmingham, AL, USA.
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BACKGROUND: Peer support has been shown to improve diabetes self-management and control, but no standard exists to link peer support interventions to clinical care. OBJECTIVE: To compare a community-based diabetes self-management education (DSME) plus mobile health (mHealth)–enhanced peer support intervention to community-based diabetes self-management education (DSME) alone for African American adults with poorly controlled type 2 diabetes. DESIGN: A randomized controlled trial. PARTICIPANTS: African American adults, age > 19 years, receiving care within a safety-net healthcare system in Jefferson County, Alabama, with a diagnosis of type 2 diabetes and a hemoglobin A1c (A1C) ≥ 7.5%. INTERVENTIONS: Participants in the intervention group received community-based diabetes self-management education (DSME) plus 6 months of mHealth-enhanced peer support, including 12 weekly phone calls, then 3 monthly calls from community health workers, who used a novel web application to communicate with participants’ healthcare teams. In the control group, participants received community-based DSME alone. MAIN MEASURES: The primary outcome was A1C; secondary outcomes included diabetes distress, depressive symptoms, self-efficacy or confidence in their ability to manage diabetes, and social support. We used mixed models repeated measures analyses to assess for between-arm differences and baseline to follow-up changes. KEY RESULTS: Of 120 participants randomized, 97 completed the study. Participants in intervention and control groups experienced clinically meaningful reduction in A1C, 10.1 (SD 1.7) to 9.6 (SD 1.9) and 9.8 (SD 1.7) to 9.1 (SD 1.9) respectively, p = 0.004. Participants in the intervention group experienced a significantly larger reduction in diabetes distress compared to the control, 2.7 (SD 1.2) to 2.1 (1.0) versus 2.6 (SD 1.1) to 2.3 (SD 1.0) p = 0.041. CONCLUSIONS: Community-based DSME with and without peer support led to improved glycemic control. Peer support linked to clinical care led to a larger reduction in diabetes distress, which has important implications for the overall wellbeing of adults with type 2 diabetes. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-020-06011-w) contains supplementary material, which is available to authorized users. Received December 4, 2019 Accepted June 23, 2020
KEY WORDS: peer support; diabetes self-management education; mobile health. J Gen Intern Med DOI: 10.1007/s11606-020-06011-w © Society of General Internal Medicine 2020
BACKGROUND
Persons with diabetes face demanding and complex daily selfmanagement activities including adherence to recommended diet, physical activity, medication(s), and blood glucose monitoring.1 Effective diabetes self-management can prevent or delay diabetes-related complications, but adherence to recomm
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