Candice Ward

Impact of Community Based Peer Support in Type 2 Diabetes: A Cluster Randomised Controlled Trial of Individual and/or Group Approaches

Background Diabetes peer support, where one person with diabetes helps guide and support others, has been proposed as a way to improve diabetes management. We have tested whether different diabetes peer support strategies can improve metabolic and/or psychological outcomes. Methods People with type 2 diabetes (n = 1,299) were invited to participate as either ‘peer’ or ‘peer support facilitator’ (PSF) in a 2x2 factorial randomised cluster controlled trial across rural communities (130 clusters) in England. Peer support was delivered over 8–12 months by trained PSFs, supported by monthly meetings with a diabetes educator. Primary end point was HbA1c. Secondary outcomes included quality of life, diabetes distress, blood pressure, waist, total cholesterol and weight. Outcome assessors and investigators were masked to arm allocation. Main factors were 1:1 or group intervention. Analysis was by intention-to-treat adjusting for baseline. Results The 4 arms were well matched (Group n = 330, 1:1(individual) n = 325, combined n = 322, control n = 322); 1035 (79•7%) completed the mid-point postal questionnaire and 1064 (81•9%) had a final HbA1c. A limitation was that although 92.6% PSFs and peers were in telephone contact, only 61.4% of intervention participants attended a face to face session. Mean baseline HbA1c was 57 mmol/mol (7•4%), with no significant change across arms. Follow up systolic blood pressure was 2•3mm Hg (0.6 to 4.0) lower among those allocated group peer-support and 3•0mm Hg (1.1 to 5.0) lower if the group support was attended at least once. There was no impact on other outcomes by intention to treat or significant differences between arms in self-reported adherence or medication. Conclusions Group diabetes peer support over 8–12 months was associated with a small improvement in blood pressure but no other significant outcomes. Long term benefits should be investigated. Trial Registration ISRCTN.com ISRCTN6696362166963621

Testing a peer support intervention for people with type 2 diabetes: a pilot for a randomised controlled trial

BackgroundPeople with Type 2 diabetes face various psycho-social, self-management and clinical care issues and evidence is mixed whether support from others with diabetes, ‘peer support’, can help. We now describe a 2 month pilot study of different peer support interventions.MethodsThe intervention was informed by formative evaluation using semi-structured interviews with health professionals, community support groups and observation of diabetes education and support groups. Invitations to participate were mailed from 4 general practices and included a survey of barriers to care. Participants were randomized by practice to receive individual, group, combined (both individual and group) or no peer support. Evaluation included ethnographic observation, semi-structured interviews and questionnaires at baseline and post-intervention.ResultsOf 1,101 invited, 15% expressed an interest in participating in the pilot. Sufficient numbers volunteered to become peer supporters, although 50% of these (8/16) withdrew. Those in the pilot were similar to other patients, but were less likely to feel they knew enough about diabetes (60.8% vs 44.6% p = 0.035) and less likely to be happy with the diabetes education/care to date (75.4% vs 55.4% p = 0.013). Key issues identified were the need to recruit peer supporters directly rather than through clinicians, to address participant diabetes educational needs early and the potential for group sessions to have lower participation rates than 1:1 sessions.ConclusionsRecruitment to a full trial of peer support within the existing study design is feasible with some amendments. Attendance emerged as a key issue needing close monitoring and additional intervention during the trial.

Effectiveness of a multidisciplinary team approach to the prevention of readmission for acute glycaemic events

To describe the effect of a combined diabetes specialist/mental health team approach to prevent readmissions for acute glycaemic events among patients with diabetes.

Empowerment-based education for established type 2 diabetes in rural England

People with newly‐diagnosed type 2 diabetes are offered structured education, but there are few programmes for those with established diabetes. The empowerment‐based education approach from the United States has been advocated as one approach that supports self‐management, but is not used in England. The aim of this study was to assess the acceptability of empowerment‐based diabetes education for patients with established type 2 diabetes.

Impact of the RAPSID Education Programme on Diabetes Knowledge among People with Type 2 Diabetes

This poster session discusses the importance of external networks in the implementation of physical activity interventions for Type 2 diabetes. It was presented at the Diabetes UK Professional Conference 2013, Manchester Central Convention Complex, Manchester, UK, 13-15 March 2013.This poster session discusses the implementation of a physical activity consultation service for adults with diabetes. It was presented at the Diabetes UK Professional Conference 2013, Manchester Central Convention Complex, Manchester, UK, 13-15 March 2013.Aims: To assess the impact of a workshop for patients with known Type 2 diabetes on diabetes knowledge. Methods: Participants in RAPSID (Randomised Controlled Trial of Peer Support in Type 2 Diabetes) (n = 1,362) were invited to attend a 3.5h workshop to increase basic diabetes knowledge on entry into the trial. Attendance was not required for trial entry. The format was based upon the ‘empowerment approach’ of Funnell/Anderson and included four topics addressing key aspects of care and common myths, followed by a question and answer workshop. Participants had already completed a baseline questionnaire and completed knowledge questionnaires based upon the Revised Diabetes Knowledge Scale (RDKS) before and after the workshop. Results: Overall, 912 participants attended the workshop, of whom 565 completed both the pre- and post-questionnaire. Those completing the pre-/post-questionnaires had similar demographic/ clinic characteristics to others, besides a higher baseline knowledge (/15: 11 ± 3 vs 10 ± 3; p = 0.002) and higher quality of life (EQ5D scale: 73 ± 18 vs 70 ± 21; p = 0.007). The 10-item RDKS increased from 69% ± 19% to 78% ± 18%; p < 0.001. Those treated with insulin (15.2% of participants) increased their knowledge least (5% ± 12% vs 10% ± 17%; p = 0.009). Expectations were met in 93.5% of participants in an anonymous post-workshop survey. Aspects thought to be particularly useful related to diet/carbohydrates and medications. Sessions frequently turned into group consultations. Conclusion: This 3.5h workshop for those with pre-existing diabetes demonstrated knowledge gaps and improved patient knowledge (less so among those receiving insulin therapy). Longterm follow-up is needed to assess the relationship between changes in diabetes knowledge and self-care.

Findings from the RAPSID (Randomised Controlled Trial of Peers Support in Type 2 Diabetes) Pilot Study

Aims: To test the processes for a 2 by 2 design randomised controlled trial of group or individual peer support for Type 2 diabetes. Methods: The intervention was informed by formative evaluation using semi-structured interviews with health professionals and community groups providing peer support and involved individual, group or combined peer support. Invitations to participate were mailed from four general practices (one control) and included a survey of barriers to care. Evaluation methods included ethnographic observation, semi-structured interviews and questionnaires at baseline and post-intervention. Results: Sufficient patientswere recruited to pilot the intervention (26 participants, six peer supporters). In all, 235 of 1,101 barrier surveys were completed, with the commonest reported barriers being lack of symptoms (60.1 per cent), others needing to knowmore about diabetes (33.1 per cent) and family members not helping (27.8 per cent). Diabetes knowledge amongst participants was lower than anticipated and peer supporters wanted a diabetes education update before their training for the support role. They particularly valued support from the research nurse in the early stages of delivering the support intervention. Participants and peer supporters wanted to continue meeting after completion of the 2-month pilot. Conclusion: This study has demonstrated that the intervention is deliverable and acceptable to people with diabetes. The identified barriers to care emphasised the importance of taking diabetes seriously when asymptomatic, and the need to enlist support from family members and others to aid self-management. These findings have prompted revisions to the intervention protocol which will be tested in the main trial.