Study Suggests Peer Mentorship Improves Glucose Control among African American Veterans with Diabetes

BACKGROUND:
The management of diabetes has proven difficult because many of the critical elements of disease management occur outside of clinical encounters. Disease-specific social support has been shown to improve diabetes self-management behaviors and may be particularly beneficial when it comes from a peer with the same condition. Financial incentives also could enhance diabetes self-care, and have shown promise in areas such as medication adherence, diet and exercise, and smoking; however, financial incentives have not been tested as a means to improving diabetes control. This randomized controlled trial of peer mentoring and financial incentives tested the efficacy of these strategies in improving glucose control among African American Veterans with persistently poor diabetes control. Over six months, 118 African American Veterans were randomized to one of three arms: usual care, peer mentorship, or financial incentive. Veterans in the usual care group were notified of their starting HbA1c and recommended goals. Veterans in the peer mentorship group were assigned a peer mentor who formerly had poor glycemic control but now had good control (HbA1c < 7.5%); mentors (also African American) and mentees communicated only by phone and talked most frequently in the first month (mean calls 4: range 0 — 30). Veterans in the financial incentive group could earn $100 by dropping their HbA1c by one point and $200 by dropping it by two points — or to 6.5%. The main outcome was HbA1c at six months. At the end of the study, participants in the mentoring group were surveyed about the program (i.e., good and bad aspects).

FINDINGS:

• Peer mentorship improved glucose control significantly among African American Veterans, and the improvement was greater than usual care or financial incentives. Over six months, HbA1c decreased from 9.8% to 8.7% among Veterans in the peer mentorship group, from 9.5% to 9.1% in the financial incentive group, and from 9.9% to 9.8% in the usual care group.
• After adjusting for covariates (e.g., patient characteristics, baseline HbA1c), the mean change relative to control was -1.07 points among Veterans in the peer mentorship group and -0.45 points in the financial incentive group.
• In the exit survey, participants in the mentorship program reported on aspects of the program they most liked, i.e., support provided (14/28), education (9/28), and the ability to commiserate with mentors (6/28). Mentors reported appreciating helping others (12/24), communicating with their mentee (7/24), and the teaching process (7/24).

LIMITATIONS:

• This study was limited to African Americans treated at one VAMC.

AUTHOR/FUNDING INFORMATION:
Drs. Long, Richardson, and Volpp are part of HSR&D's Center for Health Equity Research and Promotion, Philadelphia, PA.

Long JA, Jahnle EC, Richardson DM, Loewenstein G, and Volpp KG. Peer Mentoring and Financial Incentives to Improve Glucose Control in African American Veterans: A Randomized Controlled Trial. Annals of Internal Medicine March 20, 2012;156(6):416-24.