title: Impact of peer health coaching on glycemic control in low-income patients with diabetes: a randomized controlled trial.
abstract: OBJECTIVE
  Peer health coaches offer a potential model for extending the capacity of primary care practices to provide self-management support for patients with diabetes. We conducted a randomized controlled trial to test whether clinic-based peer health coaching, compared with usual care, improves glycemic control for low-income patients who have poorly controlled diabetes.
  
  
  METHODS
  We undertook a randomized controlled trial enrolling patients from 6 public health clinics in San Francisco. Twenty-three patients with a glycated hemoglobin (HbA1C) level of less than 8.5%, who completed a 36-hour health coach training class, acted as peer coaches. Patients from the same clinics with HbA1C levels of 8.0% or more were recruited and randomized to receive health coaching (n = 148) or usual care (n = 151). The primary outcome was the difference in change in HbA1C levels at 6 months. Secondary outcomes were proportion of patients with a decrease in HbA1C level of 1.0% or more and proportion of patients with an HbA1C level of less than 7.5% at 6 months. Data were analyzed using a linear mixed model with and without adjustment for differences in baseline variables.
  
  
  RESULTS
  At 6 months, HbA1C levels had decreased by 1.07% in the coached group and 0.3% in the usual care group, a difference of 0.77% in favor of coaching (P = .01, adjusted). HbA1C levels decreased 1.0% or more in 49.6% of coached patients vs 31.5% of usual care patients (P = .001, adjusted), and levels at 6 months were less than 7.5% for 22.0% of coached vs 14.9% of usual care patients (P = .04, adjusted).
  
  
  CONCLUSIONS
  Peer health coaching significantly improved diabetes control in this group of low-income primary care patients.
authors.affiliation: Department of Family & Community Medicine, University of California, San Francisco, CA 94143, USA. dthom@fcm.ucsf.edu
authors.forename: David H
authors.initials: DH
authors.lastname: Thom
authors.forename: Amireh
authors.initials: A
authors.lastname: Ghorob
authors.forename: Danielle
authors.initials: D
authors.lastname: Hessler
authors.forename: Diana
authors.initials: D
authors.lastname: De Vore
authors.forename: Ellen
authors.initials: E
authors.lastname: Chen
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Bodenheimer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003376:Counseling / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010379:Peer Group; D011203:Poverty; D011320:Primary Health Care / Q000379:methods*; D012495:San Francisco; D012648:Self Care / Q000379:methods*; D000078329:Workforce
chemical_list: D006442:Glycated Hemoglobin