medwireNews: Peer support substantially reduces the number of hospitalizations and acute care visits in patients with type 2 diabetes and comorbid depression, shows a randomized trial published in Diabetes Care.
The findings arise from an analysis of 360 participants (mean age 60 years, 75% women, 87% African–American) of the ENCOURAGE study, in which adults with type 2 diabetes who wanted help with self-management were randomly assigned to receive 1 year of peer support (n=168) or usual care (n=187).
Peer support involved an initial face-to-face or telephone meeting with the assigned advisor “to get to know each other, to go over the participant’s personalized diabetes report card, and to select a personal self-management goal,” Andrea Cherrington (University of Alabama at Birmingham, USA) and co-investigators explain.
Following the initial contact, peer advisors, who had experience of type 2 diabetes themselves, telephoned participants each week for the first 2 months and then at least monthly for an additional 8 months to help them to work toward their goal and provide social and emotional support.
At baseline, 52% of patients in the intervention group and 48% of those in the control group had a score of at least 5 on the Patient Health Questionnaire (PHQ-8), indicating at least mild depressive symptoms, while 25% and 26%, respectively, scored at least 10, indicating moderate-to-severe depressive symptoms.
At the end of the 15-month follow-up period, the incident rate ratio (IRR) for hospitalization in the intervention versus control groups was 0.26 per 10 patient–years, indicating that patients in the intervention group had 74% fewer visits at follow-up than those in the control group.
The number of acute care visits was also reduced in the peer support group, at an IRR of 0.55 per 10 person–years, and the researchers estimate that the intervention prevented one hospitalization and one acute care visit for every 4.2 and 3.0 participants enrolled, respectively.
Similar results were observed for participants with moderate-to-severe depressive symptoms, but there was no difference in the hospitalizations or acute care visits between the intervention and control participants who had PHQ-8 below 5.
Of note, the reduction in hospitalizations and acute care visits was not associated with a corresponding reduction in depressive symptoms, and it was not dose dependent.
Cherrington and co-authors say that the burden individuals with diabetes and comorbid depression place on the US healthcare system is increasing with the aging population.
Therefore “[h]ealth systems and providers must consider new strategies that simultaneously improve health outcomes and attend to the patient experience while managing costs,” they write.
“Peer support represents one strategy that has the potential to achieve each of these aims in the setting of diabetes and comorbid depression,” the team concludes.
By Laura Cowen
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