title: Peer support to decrease diabetes-related distress in patients with type 2 diabetes mellitus: design of a randomised controlled trial.
abstract: BACKGROUND
  Many type 2 diabetes mellitus patients face difficulties self-managing their illness, which can lead to high levels of diabetes-related distress. Diabetes distress may be decreased by peer support, as peers understand and have dealt with similar problems, and can help motivate each other. A recent systematic review concluded that evidence of benefits of peer support in patients with type 2 diabetes mellitus is too inconsistent due to weak theoretical foundation of the interventions. This study describes the design of a trial evaluating the effectiveness of a group-based, peer support programme with a strong theoretical foundation on diabetes-related distress in type 2 diabetes patients.
  
  
  METHODS
  This is a parallel group randomised controlled trial of a six session group-based peer support intervention, delivered by peer leaders and group psychotherapists, compared with one educational meeting on diabetes. At least 152 patients with a type 2 diabetes duration of three years or more and between 50 and 70 years of age, recruited via their general practitioner, will be randomised to receive the peer support intervention or one educational meeting. The intervention is developed in line with three key stages of research development of the Medical Research Council framework. The primary outcome measure for this study is diabetes-related distress. Secondary outcomes include self-management behaviour, well-being and health-related quality of life. Perceived social support is a process measure. Outcomes will be measured one month before, and 6, and 12 months after the intervention by means of self-reported questionnaires. Analysis will be on an intention-to-treat basis.
  
  
  CONCLUSIONS
  This article contains a description of the design of a study that will investigate the effect of a group-based, peer support intervention on diabetes-related distress in type 2 diabetes patients. The intervention was developed in recognition of the limited evidence, and the importance of a theoretical foundation and its implementation. Findings will contribute to knowledge in the field of peer support and patient-important outcomes in type 2 diabetes patients.
  
  
  BACKGROUND
  Dutch Trial Registry: NTR3474.
authors.affiliation: Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands. li.devries@vumc.nl.
authors.forename: Lianne
authors.initials: L
authors.lastname: de Vries
authors.forename: Amber Awa
authors.initials: AA
authors.lastname: van der Heijden
authors.forename: Esther
authors.initials: E
authors.lastname: van 't Riet
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Baan
authors.forename: Piet J
authors.initials: PJ
authors.lastname: Kostense
authors.forename: Mieke
authors.initials: M
authors.lastname: Rijken
authors.forename: Guy Ehm
authors.initials: GE
authors.lastname: Rutten
authors.forename: Giel
authors.initials: G
authors.lastname: Nijpels