A Little Help From My Friends

People with diabetes who received support and counseling from a peer did better controlling blood sugar than either those who were paid to keep their blood sugar under control or those who received usual care, a study in this issue of Annals of Internal Medicine reports. Peers may not always help, as we quip in this week's YouTube, but as Rick and I discuss in the podcast, there's plenty of evidence for how much peers can positively impact someone's life choices, as we've reported previously in a study of barbers getting involved in managing their clients' high blood pressure.

The study enrolled 118 African Americans, ages 50-70, with persistent poorly controlled diabetes into one of three groups:  those who received usual care (as Rick says in the podcast, where the physician says keep your blood sugar under control and I'll see you in the office), a peer counseling group, and a financial incentive group. African Americans were enrolled because it's well known that they experience more diabetes that is typically more poorly controlled, and a much higher rate of microvascular complications than other ethnic groups.

The study followed these folks for six months.  Usual care participants were notified of their starting hemoglobin A1c (HbA1c) levels, a measure of average blood sugar for the previous few months, and their target number, then were turned loose.  Those in the peer to peer group were assigned a peer very much like them, someone whose blood sugar had previously been poorly controlled but now had good control, and was the same approximate age, race and sex.  These pairs chatted on the telephone an average of four times the first month, with declining frequency in succeeding months.  Those who were in the financial incentive group were offered a payment of $100 if they decreased their HbA1c by 1% or $200 if they decreased it by 2%, or if they reached a level of 6.5%.

The group who received peer to peer counseling saw the biggest drop in HbA1c: 9.8% to 8.7% at the end of the study.  The other two groups saw much more modest drops, with the financial incentive group dropping from 9.5% to 9.1%, and the control group barely budging, from 9.9% to 9.8%.  Other cool things about the peer group were it was convenient for both mentors and mentees, training for mentors took only about an hour, and it was inexpensive for all concerned.  It also helped keep mentees on the straight and narrow, as they were motivated to provide a good example. Sounds like a win-win to me.

Other topics this week on PodMed include seven cardiovascular risk factors and their impact on cardiovascular events and death in JAMA, and two studies from Archives of Internal Medicine, one on endoscopic versus open hernia repair, and the other on antioxidants in people with Alzheimer's disease.  Until next week, y'all live well.



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