Improving Diabetic Outcomes

Determine whether peer mentors or financial incentives are superior to usual care in helping African American Veterans improve their HbA1c levels.

Judith A. Long, MD
Principal Investigator
Diane M. Richardson, PhD
Investigator

Background and Aim

Compared to whites, African Americans have a greater incidence of diabetes, decreased control, and higher rates of micro-vascular complications. A peer mentorship model could be a scalable approach to improving control in this population and reducing disparities in diabetic outcomes.

Aim was to determine whether peer mentors or financial incentives are superior to usual care in helping African American Veterans improve their glycosylated hemoglobin (HbA1c) levels.

Intervention and Design

A six month randomized controlled trial with a patient population of African American veterans, age 50-70 years old, with persistently poor diabetes control.

Intervention - 118 participants were randomized to one of the three arms. Usual care participants were notified of their starting HbA1c and recommended goals for HbA1c. Those in the peer mentor arm were assigned a peer mentor who formerly had poor glycemic control but now had good control (HbA1c < 7.5%) who was asked to talk with the participant at least once a week. Peer mentors were matched on race, sex, and age. Those in the financial incentive arm could earn $100 by dropping their HbA1c by one point and $200 by dropping it by two points or to a HbA1c of 6.5%.

Main Outcomes and Measures - Primary pre-specified outcome was change in assessed HbA1c with treatment assignments as randomized and incorporating all available data. When available, HbA1c values drawn during routine clinical practice and within 30 days of the intended study end date were used for patients who missed their study follow-up appointment: otherwise we imputed follow-up values.

Way to Health Use

  • Study Enrollment: Enroll and randomize participants in the study

  • Financial Incentives: Provide financial incentives to participants for adherent behavior

  • Support Partners: Provide peer mentors to participants for behavior reinforcement

Findings and Conclusion

Mentors and mentees talked the most in the first month (mean calls 4: range 0-30) and dropped to a mean of 2 calls (range 0-10) by the sixth month. HbA1c dropped from 9.9% to 9.8% in the control arm, 9.8% to 8.7% in the peer mentor arm and from 9.5% to 9.1% in the financial incentive arm. Mean change in HbA1c from baseline to 6 months relative to control was −1.07 (95% CI −1.84 to −0.31) in the peer mentor arm and −0.45 (95% CI −1.23 to 0.32) in the financial incentive arm. Peer mentorship improved glucose control in a cohort of African American Veterans with diabetes.

Publications


Peer Mentoring and Financial Incentives to Improve Glucose Control in African American Veterans: A Randomized, Controlled Trial