Study Finds Peer Mentor Interventions Ineffective Among Veterans With T2D

Peer mentor interventions did not improve long-term hemoglobin A1C (A1C) levels or yield sustained benefits among veterans with poorly controlled type 2 diabetes (T2D), according to study results published in JAMA Network Open.

Although diabetes affects roughly 9.4% of the total US population, this number is much higher among veterans, at around 16%. In addition, analyses of pharmacy costs for glycemic treatment in the Department of Veterans Affairs show care for patients with diabetes makes up a substantial portion of the Department’s resources.

Lifestyle changes and medication adherence are key factors that can determine the course of T2D, but they are often handled outside of clinical encounters. According to the authors, “Peer support models that include peers with the same chronic illness and experiential knowledge may help augment patients’ existing social support structures and improve self-care.”

Previous studies have also found peer mentor programs can help to improve glycemic control, adherence to medications, diet, exercise, and blood glucose monitoring.

To determine whether similar peer support interventions could yield long-term benefits among veterans with T2D, the researchers conducted a randomized clinical trial. The trial was split into 2 phases. In phase 1, patients were randomized to receive mentoring from peers with well-controlled diabetes whose diabetes was once in poor control or to usual care. Phase 2 involved different patients with poor glycemic control randomized to receive usual care or mentoring from former mentees in phase 1.

Between September 2012 and March 2018, 365 individuals were enrolled in phase 1 and 122 patients were enrolled in phase 2. Patients had a mean (SD) age of 60 (7.5) years, and the majority were Black (66%) males (96%).

The researchers also performed a qualitative study to examine the mentor-mentee relationship, exploring factors associated with broader program implementation.

Phase 1 mentors had to have at least 1 A1C measure less than or equal to 7.5% in the 3 months prior to enrollment but have at least 1 A1C measure greater than 8% in the 3 years prior to enrollment. former mentees who became mentors in phase 2 were not required to have achieved A1C levels less than or equal to 7.5% to become mentors, the authors wrote.

Mentors received a 1-time, 1-hour training session with monthly reinforcement sessions from research staff.

Data were collected in-person at baseline, after 6 months, and after 12 months. Analyses revealed:

• Mean phase 1 A1C change at 6 months for usual care was −0.20% (95% CI, −0.46% to 0.06%) vs −0.52% (95% CI, −0.76% to −0.29%) for mentees (P = .06)
• Mean phase 2 A1C change at 6 months for usual care was −0.46% (95% CI, −1.02% to 0.10%) vs 0.08% (95% CI, −0.42% to 0.57%) for mentees (P = .16)
• There were no differences in secondary outcomes or A1C levels at 12 months
• There was no benefit to past mentees who became mentors
• Ad hoc analyses indicated that initial gains were more pronounced in patients with starting A1C levels above 8% and that mentoring from a former mentee who did not improve while a mentee could lead to worse outcomes

The researchers conceded that although the mentor training was designed to make intervention easier to implement, “a higher-touch intervention may have led to improved diabetes-related outcomes.”

They also found that having a mentor who did not improve their own glycemic control in phase 1 was associated with worsening control for their mentees. Thus, using former mentees who improved glycemic control may be the best approach to obtain optimal outcomes, they wrote.

Findings may not be generalizable outside of the veterans' community, marking a limitation of the study.

“Future studies to determine how best to facilitate mentor and mentee engagement and optimal practices to create long-term sustainable peer-mentoring models may be warranted,” the authors concluded.

Reference:

Long JA, Ganetsky VS, Canamucio A, Dicks TN, Heisler M, Marcus SC. Effect of peer mentors in diabetes self-management vs usual care on outcomes in US veterans with type 2 diabetes. JAMA Netw Open. 2020;3(9):e2016369. doi:10.1001/jamanetworkopen.2020.16369