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Randomized Controlled Trial
. 2015 Aug;13 Suppl 1(Suppl 1):S27-35.
doi: 10.1370/afm.1819.

Peer-Led, Empowerment-Based Approach to Self-Management Efforts in Diabetes (PLEASED): A Randomized Controlled Trial in an African American Community

Tricia S Tang  1 , Martha M Funnell  2 , Brandy Sinco  3 , Michael S Spencer  3 , Michele Heisler  4
Affiliations
Randomized Controlled Trial

Peer-Led, Empowerment-Based Approach to Self-Management Efforts in Diabetes (PLEASED): A Randomized Controlled Trial in an African American Community

Tricia S Tang et al. Ann Fam Med. 2015 Aug.

Abstract

Purpose: 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.

Keywords: blood glucose control; diabetes; health care disparities; peer support; randomized controlled trial; self-management.

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Figures

Figure 1
Figure 1
CONSORT 2012 flow diagram: PLEASED Study
Figure 2
Figure 2
Trajectory of unadjusted mean LDL cholesterol levels over time Note: At baseline, LDL cholesterol (LDL-C) levels did not differ significantly between groups. All increases within the Control group were significant (P <.05) relative to the Intervention group. Within-group changes from baseline to 3, 9, and 15 months were all significant for the Control group (P = .01).
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