Clinic-based Peer Coaching Improves A1c

A1c’s fall 1-3 points with coaching….

Clinic-based peer health coaching significantly improved type 2 diabetes control among low-income primary-care patients, a 6-month randomized study found. Peer health coaches are laypeople with the same disease as those they assist, who are trained to provide ongoing support for self-management to small groups of clients. "Because they experience similar challenges of living with the same chronic condition as the patients they assist, peer supporters are uniquely poised to engage and motivate other patients in self-management," David H. Thom, MD, PhD Department of Family & Community Medicine San Francisco General Hospital, and colleagues write.

Potential coaches had to have HbA1c levels less than 8.5% and be recommended by their primary care physicians. Patients all had HbA1c levels of 8% or higher. The 24 coach trainees (mean age, 58 years) received 36 hours of training over 8 weeks, based on a curriculum that includes instruction in active listening and nonjudgmental communication, helping with diabetes self-management skills, providing emotional and social support, assisting with lifestyle change and medication understanding/adherence, and accessing community resources.

In this study, almost 300 patients were randomly assigned to receive either coaching or usual care. Patients were assessed via questionnaires and clinical evaluation at baseline and at 6 months.

At baseline, the patients mean HbA_1c was 10.1% for the 148 patients in the coaching group and 9.8% for the 151 patients assigned to usual care. At 6 months, HbA_1c levels had fallen by 1.1 percentage points in the coached group, a significantly greater drop than the 0.3 percentage points seen with usual care (P = .01). Also, 22% of the coached patients achieved HbA_1c levels below 7.5% compared with 8% in the usual-care group.

Ann Fam Med 2013 11:102-103