medwireNews: People with newly detected type 2 diabetes may gain more from a lifestyle intervention if supported by peers who have had the condition for longer, suggest findings from a randomized trial.
The 432 participants of this trial were screened for prediabetes as part of the previously reported Norfolk Diabetes Prevention Study, but proved to actually have type 2 diabetes, based on paired fasting plasma glucose tests of at least 7.0 mmol/L (126.2 mg/dL) or glycated hemoglobin (HbA1c) tests of at least 48.0 mmol/mol (6.5%).
They were randomly assigned to receive the same lifestyle intervention as used in the main trial, similar to established national diabetes prevention programs, with (n=141) or without (n=142) a peer mentor, or to usual care (n=149).
The intervention group undertook six group sessions over 12 months and then up to 15 maintenance sessions 8 weeks apart. In addition, the mentors made up to 18 motivational telephone calls to their assigned participants (up to seven per mentor), in which they discussed progress and barriers, achievement of goals, and plans of action.
The primary outcome of HbA1c after 12 months was lower in the combined intervention groups than in the control group, but this was significant only in the group with the peer mentors, at 45.6 mmol/mol (6.3%), 46.5 mmol/mol (6.4%), and 48.5 mmol/mol (6.6%) for people with and without mentors and for those in the control group, respectively.
However, these “modest” differences did not persist at 24 months, and so the long-term clinical benefit “is unclear and may not translate to better clinical outcomes,” say Michael Sampson (University of East Anglia, Norwich, UK) and co-researchers.
In subgroup analyses, the effect of the intervention on HbA1c levels was greater in people younger than 65 years than in older people, and in those who were taking oral antidiabetes medications than in those who were not. Again, these benefits were confined to people with a peer mentor.
“The use of trained lay volunteers (with or without diabetes) to support the clinical management of people with type 2 diabetes is an attractive model in terms of workforce planning and limiting cost,” write the researchers in BMC Medicine.
They add: “These findings are relevant to the recent emphasis on community-level interventions and social prescribing through integrated care services or the voluntary sectors.”
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