Cardiovascular risk outcome and program evaluation of a cluster randomised controlled trial of a community-based, lay peer led program for people with diabetes.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968562 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2458 (Electronic) Linking ISSN: 14712458 NLM ISO Abbreviation: BMC Public Health Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Cardiovascular Diseases*/etiology ; Cardiovascular Diseases*/prevention & control ; Peer Group* ; Program Evaluation* ; Residence Characteristics* ; Self Care* ; Social Support*; Diabetes Mellitus, Type 2/*complications; Aged ; Australia ; Counseling ; Female ; Group Processes ; Health Education ; Health Promotion ; Humans ; Male ; Middle Aged ; Primary Health Care ; Prospective Studies ; Quality of Life ; Risk Factors

Background: The 2013 Global Burden of Disease Study demonstrated the increasing burden of diabetes and the challenge it poses to the health systems of all countries. The chronic and complex nature of diabetes requires active self-management by patients in addition to clinical management in order to achieve optimal glycaemic control and appropriate use of available clinical services. This study is an evaluation of a "real world" peer support program aimed at improving the control and management of type 2 diabetes (T2DM) in Australia.
Methods: The trial used a randomised cluster design with a peer support intervention and routine care control arms and 12-month follow up. Participants in both arms received a standardised session of self-management education at baseline. The intervention program comprised monthly community-based group meetings over 12 months led by trained peer supporters and active encouragement to use primary health care and other community resources and supports related to diabetes. Clinical, behavioural and other measures were collected at baseline, 6 and 12 months. The primary outcome was the predicted 5 year cardiovascular disease risk using the United Kingdom Prospective Diabetes Study (UKPDS) Risk Equation at 12 months. Secondary outcomes included clinical measures, quality of life, measures of support, psychosocial functioning and lifestyle measures.
Results: Eleven of 12 planned groups were successfully implemented in the intervention arm. Both the usual care and the intervention arms demonstrated a small reduction in 5 year UKPDS risk and the mean values for biochemical and anthropometric outcomes were close to target at 12 months. There were some small positive changes in self-management behaviours.
Conclusions: The positive changes in self-management behaviours among intervention participants were not sufficient to reduce cardiovascular risk, possibly because approximately half of the study participants already had quite well controlled T2DM at baseline. Future research needs to address how to enhance community based programs so that they reach and benefit those most in need of resources and supports to improve metabolic control and associated clinical outcomes.
Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12609000469213 . Registered 16 June 2009.

Ann Med. 2001 Jul;33(5):337-43. (PMID: 11491192)
Aust J Prim Health. 2015;21(2):205-13. (PMID: 24618400)
J Gen Intern Med. 2001 Sep;16(9):606-13. (PMID: 11556941)
JAMA Intern Med. 2014 Jun;174(6):972-81. (PMID: 24781960)
Annu Rev Public Health. 2014;35:363-83. (PMID: 24387085)
BMC Public Health. 2012 Oct 04;12:843. (PMID: 23035666)
Diabetes Educ. 2009 Jul-Aug;35(4):641-51. (PMID: 19407333)
Diabetes Care. 2014 Jun;37(6):1525-34. (PMID: 24722495)
Int J Behav Med. 2015 Jun;22(3):374-83. (PMID: 24733698)
Diabetes Educ. 2012 May-Jun;38(3):357-65. (PMID: 22546740)
Diabetes Care. 2012 Jan;35 Suppl 1:S101-8. (PMID: 22187467)
Ann Fam Med. 2015 Aug;13 Suppl 1:S18-26. (PMID: 26304967)
JAMA. 1999 Nov 10;282(18):1737-44. (PMID: 10568646)
Circulation. 2007 Jul 10;116(2):151-7. (PMID: 17576864)
Chronic Illn. 2013 Dec;9(4):258-67. (PMID: 23585636)
Am J Public Health. 2001 Dec;91(12):2010-2. (PMID: 11726385)
Prev Chronic Dis. 2012;9:E36. (PMID: 22239751)
Diabetes Educ. 2008 Mar-Apr;34(2):266-76. (PMID: 18375776)
Diabetes Care. 2008 Mar;31(3):408-14. (PMID: 18096810)
Diabetes Educ. 2014 Mar-Apr;40(2):223-30. (PMID: 24481174)
Diabetes Care. 2012 Sep;35(9):1835-44. (PMID: 22699290)
Ann Fam Med. 2015 Aug;13 Suppl 1:S9-17. (PMID: 26304977)
Diabetes Care. 2005 Mar;28(3):626-31. (PMID: 15735199)
Ann Fam Med. 2008 May-Jun;6(3):246-52. (PMID: 18474888)
Ann Fam Med. 2013 Mar-Apr;11(2):137-44. (PMID: 23508600)
BMC Med Res Methodol. 2012 Aug 31;12:132. (PMID: 22938205)
Fam Pract. 2010 Jun;27 Suppl 1:i6-16. (PMID: 19276176)
Ann Fam Med. 2015 Aug;13 Suppl 1:S59-65. (PMID: 26304973)
Clin Sci (Lond). 2001 Dec;101(6):671-9. (PMID: 11724655)
PLoS One. 2015 Mar 18;10(3):e0120277. (PMID: 25785452)
Health Aff (Millwood). 2012 Jan;31(1):130-9. (PMID: 22232103)
BMJ. 2000 Aug 12;321(7258):412-9. (PMID: 10938049)
Ann Fam Med. 2015 Aug;13 Suppl 1:S27-35. (PMID: 26304969)
BMJ. 2000 Aug 12;321(7258):405-12. (PMID: 10938048)
BMC Public Health. 2015 May 06;15:471. (PMID: 25943398)
BMJ. 2011 Feb 15;342:d715. (PMID: 21324992)
Ann Intern Med. 2010 Oct 19;153(8):507-15. (PMID: 20956707)
J Gen Intern Med. 2013 Jul;28(7):938-42. (PMID: 23404203)
Med J Aust. 2011 Jul 4;195(1):45-6. (PMID: 21728944)
Health Aff (Millwood). 2015 Sep;34(9):1523-30. (PMID: 26355054)
Fam Pract. 2010 Jun;27 Suppl 1:i62-8. (PMID: 20483801)
Diabetes Educ. 2013 Sep-Oct;39(5):655-63. (PMID: 23782621)
Annu Rev Public Health. 2014;35:399-421. (PMID: 24387091)
Med Care. 1986 Jan;24(1):67-74. (PMID: 3945130)
Lancet. 2015 Aug 22;386(9995):743-800. (PMID: 26063472)
BMJ. 2012 Sep 04;345:e5661. (PMID: 22951546)
J Gen Intern Med. 2007 Feb;22(2):215-22. (PMID: 17356989)
Cochrane Database Syst Rev. 2009 Jan 21;(1):CD005268. (PMID: 19160249)
Diabetes Care. 2000 Jul;23(7):943-50. (PMID: 10895844)

Investigator: B Oldenburg; J Dunbar; P Reddy; V Hagger; G Johnson; M de Courten; R Wolfe; R Carter; P Absetz; A Zaini
Keywords: Diabetes; Diabetes self-care behaviours; Medication adherence; Peer support; Self-management; UKPDS

ANZCTR ACTRN12609000469213

Date Created: 20160826 Date Completed: 20170809 Latest Revision: 20220317

20221213

PMC4995663

10.1186/s12889-016-3538-3

27558630