Cardiovascular risk outcome and program evaluation of a cluster randomised controlled trial of a community-based, lay peer led program for people with diabetes

BMC Public Health

Research Article

J. A. Dunbar¹  M. Brand²  R. Wolfe²  M. A. Riddell²  H. Li³  B. Oldenburg⁴  Z. Aziz⁴  P. Absetz⁵ 

[1] Deakin Population Health Strategic Research Centre, Deakin University, Melbourne, Australia;Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, The Alfred Centre, 99 Commercial Road, 3004, Melbourne, Victoria, Australia;Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, The Alfred Centre, 99 Commercial Road, 3004, Melbourne, Victoria, Australia;Institute of Chronic Disease Control, Beijing Centers for Disease Control and Prevention, Beijing, People’s Republic of China;Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, The Alfred Centre, 99 Commercial Road, 3004, Melbourne, Victoria, Australia;Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia;School of Health Sciences, University of Tampere, Tampere, Finland;

关键词: Diabetes;    Self-management;    Peer support;    Medication adherence;    Diabetes self-care behaviours;    UKPDS;   

DOI  :  10.1186/s12889-016-3538-3

 received in 2015-11-13, accepted in 2016-08-17,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundThe 2013 Global Burden of Disease Study demonstrated the increasing burden of diabetes and the challenge it poses to the health systems of all countries. The chronic and complex nature of diabetes requires active self-management by patients in addition to clinical management in order to achieve optimal glycaemic control and appropriate use of available clinical services. This study is an evaluation of a “real world” peer support program aimed at improving the control and management of type 2 diabetes (T2DM) in Australia.MethodsThe trial used a randomised cluster design with a peer support intervention and routine care control arms and 12-month follow up. Participants in both arms received a standardised session of self-management education at baseline. The intervention program comprised monthly community-based group meetings over 12 months led by trained peer supporters and active encouragement to use primary health care and other community resources and supports related to diabetes. Clinical, behavioural and other measures were collected at baseline, 6 and 12 months. The primary outcome was the predicted 5 year cardiovascular disease risk using the United Kingdom Prospective Diabetes Study (UKPDS) Risk Equation at 12 months. Secondary outcomes included clinical measures, quality of life, measures of support, psychosocial functioning and lifestyle measures.ResultsEleven of 12 planned groups were successfully implemented in the intervention arm. Both the usual care and the intervention arms demonstrated a small reduction in 5 year UKPDS risk and the mean values for biochemical and anthropometric outcomes were close to target at 12 months. There were some small positive changes in self-management behaviours.ConclusionsThe positive changes in self-management behaviours among intervention participants were not sufficient to reduce cardiovascular risk, possibly because approximately half of the study participants already had quite well controlled T2DM at baseline. Future research needs to address how to enhance community based programs so that they reach and benefit those most in need of resources and supports to improve metabolic control and associated clinical outcomes.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12609000469213. Registered 16 June 2009.

【 授权许可】

CC BY   
© The Author(s). 2016