Using Peer Support to Prevent Diabetes: Results of a Pragmatic RCT.
Using Peer Support to Prevent Diabetes: Results of a Pragmatic RCT.
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DOI：
10.1016/j.amepre.2023.02.015
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发表时间：
2023-03
影响因子：
5.5
通讯作者：
M. Heisler;Wendy T. Dyer;Holly Finertie;Shelley Stoll;Deanne Wiley;Cassie D. Turner;Tali Sedgwick;J. Kullgren;C. Richardson;M. Hedderson;J. Schmittdiel
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作者：
M. Heisler;Wendy T. Dyer;Holly Finertie;Shelley Stoll;Deanne Wiley;Cassie D. Turner;Tali Sedgwick;J. Kullgren;C. Richardson;M. Hedderson;J. Schmittdiel
介绍高接触结构化糖尿病预防计划在降低体重和HbA 1c方面是有效的，但其强度水平可能会对参与产生障碍。同伴支持计划可以改善2型糖尿病成人患者的临床结局，但其在糖尿病预防方面的有效性尚不清楚。本研究探讨了是否低强度的同伴支持计划改善的结果比增强常规护理在不同人群的prediabetes.Study designThe干预进行了测试，在一个务实的2-arm随机对照试验设置/participantsParticipants是成年人与prediabetes在三个healthcare centers.InterventionParticipants随机增强常规护理手臂收到的教育材料。“利用同伴支持来帮助糖尿病前期预防和治疗”小组的参与者与一位同伴支持者进行了匹配：另一位已经改变健康生活方式并接受过自主支持行动计划培训的患者。同伴支持者被要求每周给同伴提供电话支持，指导他们朝着行为目标采取具体的行动步骤，持续6个月，然后每月提供支持，持续6个月。主要结果测量体重和HbA 1c的主要结果的变化以及正式糖尿病预防计划的登记、自我报告的饮食、身体活动、健康特定的社会支持、自我效能、动机、结果数据收集时间为2018年10月至2022年3月，分析于2022年9月完成。在355例随机化患者中，在意向治疗分析中，6个月和12个月时HbA 1c或体重变化无组间差异。使用同伴支持来帮助预防和治疗糖尿病前期参与者更有可能在6个月（AOR= 2.45，p =0.009）和12个月（AOR= 2.21，p =0.016）时参加结构化计划，并在6个月（4.49，p =0.026）和12个月（4.22，p =0.034）时报告吃全谷物。他们在6个月（6.39，p <0.001）和12个月（5.48，p <0.001）时报告了对糖尿病预防行为的社会支持的更大改善，其他措施没有差异。重要的是要检查同伴支持是否可以有效地补充高强度，结构化的糖尿病预防计划。试验注册该试验注册在ClinicalTrials.gov，NCT 03689530。完整方案可在https://clinicaltrials.gov/ct2/show/NCT03689530上获得。
IntroductionHigh-contact structured diabetes prevention programs are effective in lowering weight and HbA1cs, yet their intensity level can create barriers to participation. Peer support programs improve clinical outcomes among adults with Type 2 diabetes, but their effectiveness in diabetes prevention is unknown. This study examined whether a low-intensity peer support program improved outcomes more than enhanced usual care in a diverse population with prediabetes.Study designThe intervention was tested in a pragmatic 2-arm RCT.Setting/participantsParticipants were adults with prediabetes at three healthcare centers.InterventionParticipants randomized to the enhanced usual care arm received educational materials. Participants in the Using Peer Support to Aid in Prevention and Treatment in Prediabetes arm were matched with a peer supporter: another patient who had made healthy lifestyle changes and was trained in autonomy-supportive action planning. Peer supporters were instructed to provide weekly telephone support to their peers on specific action steps toward behavioral goals for 6 months, then monthly support for 6 months.Main outcome measuresChanges in primary outcomes of weight and HbA1c and secondary outcomes of enrollment in formal diabetes prevention programs, self-reported diet, physical activity, health-specific social support, self-efficacy, motivation, and activation at 6 and 12 months were examined.ResultsData collection occurred from October 2018 to March 2022, with analyses completed in September 2022. Among 355 randomized patients, in intention-to-treat analyses, there were no between-group differences in HbA1c or weight changes at 6 and 12 months. Using Peer Support to Aid in Prevention and Treatment in Prediabetes participants were more likely to enroll in structured programs at 6 (AOR=2.45,p=0.009) and 12 (AOR=2.21,p=0.016) months and to report eating whole grains at 6 (4.49,p=0.026) and 12 (4.22,p=0.034) months. They reported greater improvements in perceived social support for diabetes prevention behaviors at 6 (6.39,p<0.001) and 12 (5.48,p<0.001) months, with no differences in other measures.ConclusionsA stand-alone, low-intensity peer support program improved social support and participation in formal diabetes prevention programs but not weight or HbA1c. It will be important to examine whether peer support could effectively complement higher-intensity, structured diabetes prevention programs.Trial registrationThis trial is registered at ClinicalTrials.gov, NCT03689530. Full protocol available at https://clinicaltrials.gov/ct2/show/NCT03689530.