Peer Coaches to Improve Diabetes Outcomes in Rural Alabama: A Cluster Randomized Trial.
PURPOSE
It is unclear whether peer coaching is effective in minority populations living with diabetes in hard-to-reach, under-resourced areas such as the rural South. We examined the effect of an innovative peer-coaching intervention plus brief education vs brief education alone on diabetes outcomes.


METHODS
This was a community-engaged, cluster-randomized, controlled trial with primary care practices and their surrounding communities serving as clusters. The trial enrolled 424 participants, with 360 completing baseline and follow-up data collection (84.9% retention). The primary outcomes were change in glycated hemoglobin (HbA1c), systolic blood pressure (BP), low density lipoprotein cholesterol (LDL-C), body mass index (BMI), and quality of life, with diabetes distress and patient activation as secondary outcomes. Peer coaches were trained for 2 days in community settings; the training emphasized motivational interviewing skills, diabetes basics, and goal setting. All participants received a 1-hour diabetes education class and a personalized diabetes report card at baseline. Intervention arm participants were also paired with peer coaches; the protocol called for telephone interactions weekly for the first 8 weeks, then monthly for a total of 10 months.


RESULTS
Due to real-world constraints, follow-up was protracted, and intervention effects varied over time. The analysis that included the 68% of participants followed up by 15 months showed only a significant increase in patient activation in the intervention group. The analysis that included all participants who eventually completed follow-up revealed that intervention arm participants had significant differences in changes in systolic BP (P = .047), BMI (P = .02), quality of life (P = .003), diabetes distress (P = .004), and patient activation (P = .03), but not in HbA1c (P = .14) or LDL-C (P = .97).


CONCLUSION
Telephone-delivered peer coaching holds promise to improve health for individuals with diabetes living in under-resourced areas.
['Safford|Monika M|MM|', 'Andreae|Susan|S|', 'Cherrington|Andrea L|AL|', 'Martin|Michelle Y|MY|', 'Halanych|Jewell|J|', 'Lewis|Marquita|M|', 'Patel|Ashruta|A|', 'Johnson|Ethel|E|', 'Clark|Debra|D|', 'Gamboa|Christopher|C|', 'Richman|Joshua S|JS|']
D000368:Aged D000407:Alabama D001794:Blood Pressure D015992:Body Mass Index D008078:Cholesterol, LDL D016000:Cluster Analysis D003376:Counseling D003920:Diabetes Mellitus D005260:Female D006442:Glycated Hemoglobin A D006801:Humans D008297:Male D008875:Middle Aged D010379:Peer Group D011788:Quality of Life D012424:Rural Population D012648:Self Care D012944:Social Support D013689:Telephone D016896:Treatment Outcome D035862:Vulnerable Populations
diabetes primary care Peer health coaching self-management support