Introduction
High-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 design
The intervention was tested in a pragmatic 2-arm RCT.
Setting/participants
Participants were adults with prediabetes at 3 healthcare centers.
Intervention
Participants 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 measures
Changes 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.
Results
Data 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.
Conclusions
A 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 registration
This trial is registered at ClinicalTrials.gov, NCT03689530. Full protocol available
at https://clinicaltrials.gov/ct2/show/NCT03689530.
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Article info
Publication history
Published online: March 08, 2023
Publication stage
In Press Journal Pre-ProofIdentification
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© 2023 Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.
