title: Impact of community based peer support in type 2 diabetes: a cluster randomised controlled trial of individual and/or group approaches.
abstract: BACKGROUND
  Diabetes peer support, where one person with diabetes helps guide and support others, has been proposed as a way to improve diabetes management. We have tested whether different diabetes peer support strategies can improve metabolic and/or psychological outcomes.
  
  
  METHODS
  People with type 2 diabetes (n = 1,299) were invited to participate as either 'peer' or 'peer support facilitator' (PSF) in a 2x2 factorial randomised cluster controlled trial across rural communities (130 clusters) in England. Peer support was delivered over 8-12 months by trained PSFs, supported by monthly meetings with a diabetes educator. Primary end point was HbA1c. Secondary outcomes included quality of life, diabetes distress, blood pressure, waist, total cholesterol and weight. Outcome assessors and investigators were masked to arm allocation. Main factors were 1:1 or group intervention. Analysis was by intention-to-treat adjusting for baseline.
  
  
  RESULTS
  The 4 arms were well matched (Group n = 330, 1:1(individual) n = 325, combined n = 322, control n = 322); 1035 (79·7%) completed the mid-point postal questionnaire and 1064 (81·9%) had a final HbA1c. A limitation was that although 92.6% PSFs and peers were in telephone contact, only 61.4% of intervention participants attended a face to face session. Mean baseline HbA1c was 57 mmol/mol (7·4%), with no significant change across arms. Follow up systolic blood pressure was 2·3 mm Hg (0.6 to 4.0) lower among those allocated group peer-support and 3·0 mm Hg (1.1 to 5.0) lower if the group support was attended at least once. There was no impact on other outcomes by intention to treat or significant differences between arms in self-reported adherence or medication.
  
  
  CONCLUSIONS
  Group diabetes peer support over 8-12 months was associated with a small improvement in blood pressure but no other significant outcomes. Long term benefits should be investigated.
  
  
  BACKGROUND
  ISRCTN.com ISRCTN6696362166963621.
authors.affiliation: Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, England.
authors.forename: David
authors.initials: D
authors.lastname: Simmons
authors.affiliation: Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, England.
authors.forename: A Toby
authors.initials: AT
authors.lastname: Prevost
authors.affiliation: Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, England.
authors.forename: Chris
authors.initials: C
authors.lastname: Bunn
authors.affiliation: Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, England.
authors.forename: Daniel
authors.initials: D
authors.lastname: Holman
authors.affiliation: Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, England.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Parker
authors.affiliation: Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, England.
authors.forename: Simon
authors.initials: S
authors.lastname: Cohn
authors.affiliation: Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, England.
authors.forename: Sarah
authors.initials: S
authors.lastname: Donald
authors.affiliation: Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, England.
authors.forename: Charlotte A M
authors.initials: CA
authors.lastname: Paddison
authors.affiliation: Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, England.
authors.forename: Candice
authors.initials: C
authors.lastname: Ward
authors.affiliation: Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, England.
authors.forename: Peter
authors.initials: P
authors.lastname: Robins
authors.affiliation: Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, England.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Graffy
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010379:Peer Group; D012111:Residence Characteristics; D012944:Social Support