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ADA: Diabetes Patients Lead Peers to Healthier Status

Training people with diabetes to teach other patients improves utilization of medications and results in lifestyle changes….

Garry Tobin, MD, associate professor of medicine at Washington University and director of the Diabetes Center at Barnes Jewish Hospital, St. Louis stated that  patients enrolled in the Diabetes Network of St. Louis achieved a reduction in glycosylated hemoglobin A1c (HbA1c) from 7.38% at baseline to 7.18% (P=0.001) after two years of the program. 

Dr. Tobin said, “The most important resource in my practice is not my colleagues or other physicians, it is the patients we have in our center.”  

“We have patients who have had diabetes 50 years and that experience has been able to make them successful in controlling their disease, and this gives them the opportunity to go back out into the community and be successful in helping other people,” he said. 

The use of the unpaid, volunteer group leaders had measurable success among the 186 patients who agreed to be part of the study. Overall, more than 400 people — the large majority of whom had type 2 diabetes — took part in the activities of the 45 groups of patients that attended meetings at 34 sites, said co-investigator Eric Armbrecht, PhD, assistant professor of medicine at St. Louis University. 

After two years, in addition to improvement in HbA1c, the researchers reported:

  • Average systolic blood pressure fell three points, from 141 mm Hg to 138 mm Hg (P=0.026).
  • Average diastolic blood pressure fell from 78.2 mm Hg to 76.6 mm Hg (P=0.046).
  • Average body mass index fell from 34 kg/m2 to 33.7 kg/m2 (P=0.025). 

The researchers also demonstrated that blood glucose monitoring increased, consumption of fruits and vegetables increased, and physical activity increased among patients who started the trial with HbA1c greater than 8%. 

Armbrecht said the volunteers go through a specific training program that is done in partnership with the Washington University Diabetes Center at Barnes Jewish Hospital. 

“Volunteers have about a 25- to 30-hour course of training to prepare them to lead a group of peers that meets in a community setting,” he explained. In the St. Louis program, the doctors selected patients they thought would be good group leaders.  “The sessions have different topics to focus the conversation, but in each session, one of the common discussion points is an assessment of goal-setting, progress, and a lot of group support.”

Martin Abrahamson, MD, associate professor of medicine at the Joslin Clinic/Harvard Medical School, Boston, said, “We think that these programs should go out into the community. We are looking into doing similar programs among our patients.” 

David Kendall, MD, chief scientific and medical officer at the American Diabetes Association stated that, “These patients reduced their HbA1c, their body mass index didn’t go up, their blood pressure went down, they ate better, they did more monitoring.” “I think this is additional encouraging evidence that integrating diabetes care support into the community setting at low cost with limited resources has additional beneficial effects. Given the size of the diabetic epidemic, additional delivery approaches are going to be essential.”

Practice Pearls: 
  • Explain that an education program using unpaid volunteers with diabetes as leaders resulted in improved HbA1c in patients who attended the program. 
  • Note that blood pressure, BMI, diet, physical activity, and monitoring of blood glucose all also improved following the peer education program.

Presented at the ADA 71st Scientific Sessions, 2011