title: Peer-Led, Empowerment-Based Approach to Self-Management Efforts in Diabetes (PLEASED): A Randomized Controlled Trial in an African American Community.
abstract: OBJECTIVE
  We compared a 3-month diabetes self-management education (DSME) program followed by a 12-month peer support intervention with a 3-month DSME program alone in terms of initial and sustained improvements in glycated hemoglobin (HbA1c). Secondary outcomes were risk factors for cardiovascular disease (CVD), diabetes distress, and social support.
  
  
  METHODS
  We randomized 106 community-dwelling African American adults with type 2 diabetes to a 3-month DSME program followed by 12 months of weekly group sessions and supplementary telephone support delivered by peer leaders or to a 3-month DSME program with no follow-up peer support. Assessments were conducted at baseline, 3, 9, and 15 months.
  
  
  RESULTS
  No changes in HbA1c were observed at 3 months or at 15 months for either group. The peer support group either sustained improvement in key CVD risk factors or stayed the same while the control group worsened at 15 months. At 15 months, the peer-support group had significantly lower low-density lipoprotein cholesterol levels (-15 mg/dL, P = .03), systolic blood pressure (-10 mm Hg, P = .01), diastolic blood pressure (-8.3 mm Hg, P = .001), and body mass index (-0.8 kg/m(2), P = .032) than the DSME-alone group.
  
  
  CONCLUSIONS
  In this population of African American adults, an initial DSME program, whether or not followed by 12 months of peer support, had no effect on glycemic control. Participants in the peer-support arm of the trial did, however, experience significant improvements in some CVD risk factors or stay approximately the same while the control group declined.
authors: University of British Columbia Department of Medicine, Vancouver, British Columbia tricia.tang@vch.ca.
authors: Tricia S
authors: TS
authors: Tang
authors: University of Michigan Department of Learning Health Sciences. Ann Arbor Michigan.
authors: Martha M
authors: MM
authors: Funnell
authors: University of Michigan School of Social Work, Ann Arbor, Michigan.
authors: Brandy
authors: B
authors: Sinco
authors: University of Michigan School of Social Work, Ann Arbor, Michigan.
authors: Michael S
authors: MS
authors: Spencer
authors: University of Michigan Department of Internal Medicine, Ann Arbor, Michigan Ann Arbor VA Center for Clinical Management Research (CCMR), Ann Arbor, Michigan.
authors: Michele
authors: M
authors: Heisler
mesh_terms: D001741:Black or African American / Q000523:psychology; D000368:Aged; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D008078:Cholesterol, LDL / Q000097:blood; D003376:Counseling / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000523:psychology / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010379:Peer Group; D011209:Power, Psychological; D012648:Self Care / Q000379:methods* / Q000523:psychology; D012944:Social Support
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: blood glucose control; diabetes; health care disparities; peer support; randomized controlled trial; self-management