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Research ArticleOriginal Research

Impact of Peer Health Coaching on Glycemic Control in Low-Income Patients With Diabetes: A Randomized Controlled Trial

David H. Thom, Amireh Ghorob, Danielle Hessler, Diana De Vore, Ellen Chen and Thomas A. Bodenheimer
The Annals of Family Medicine March 2013, 11 (2) 137-144; DOI: https://doi.org/10.1370/afm.1443
David H. Thom
Department of Family & Community Medicine, University of California, San Francisco, California
MDPhD
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  • For correspondence: dthom@fcm.ucsf.edu
Amireh Ghorob
Department of Family & Community Medicine, University of California, San Francisco, California
MPH
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Danielle Hessler
Department of Family & Community Medicine, University of California, San Francisco, California
PhD
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Diana De Vore
Department of Family & Community Medicine, University of California, San Francisco, California
BS
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Ellen Chen
Department of Family & Community Medicine, University of California, San Francisco, California
MD
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Thomas A. Bodenheimer
Department of Family & Community Medicine, University of California, San Francisco, California
MD
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    Figure 1

    Screening, randomization, and completion.

    EHR = electronic health record, HbA1c = glycated hemoglobin; LDL-C = low-density lipoprotein cholesterol.

    a Moved out of area (n = 4), not sure will continue to get care at current clinic (n = 15), enrolled in another study (n = 5), other (n = 24).

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    Table 1

    Baseline Characteristics of Coaches and Patients by Study Arm

    VariableCoaches (n = 24)Coaching Arm (n = 148)Usual Care Arm (n = 151)
    Age, mean (SD), y58.0 (8.1)56.3 (10.3)54.1 (10.4)
    Female, %66.751.453.0
    Primary language not English, %25.045.949.0
    Born outside United States, %33.347.354.0
    Married/living as married, %29.230.443.7
    Working outside home, %33.324.138.5
    Income (per year)
      <$10,00039.160.860.4
      $10,000 to $20,00043.525.728.5
      >$20,00017.313.510.7
    Less than high school education, %12.535.637.1
    Race/ethnicity, %
      White non-Hispanic12.511.510.0
      White Hispanic20.244.648.7
      Black/African American37.531.830.7
      Other16.712.110.6
    Hypertension, %62.588.577.5
    Hyperlipidemia, %62.569.668.2
    Smoked in past 30 days, %16.725.726.5
    Using insulin at baseline, %25.060.150.0
    Years with diabetes, mean (SD)10.6 (12.3)9.1 (9.1)8.7 (8.8
    HbA1c, %6.88 (0.76)10.14 (2.01)9.84 (1.95)
    LDL-C, mean (SD), mg/dL102.0 (38.8)98.8 (34.2)95.7 (35.8)
    SBP, mean (SD), mm Hg133.5 (16.8)143.0 (23.9)143.4(22.3)
    Body mass index, mean (SD), kg/m235.2 (11.9)35.0 (8.3)32.5 (8.5)
    • HbA1c = glycated hemoglobin; LDL-C = low-density lipoprotein cholesterol; SBP = systolic blood pressure.

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    Table 2

    Outcomes for Patients With HbA1C Levels Measured at 6 Months

    OutcomeHealth Coaching (n = 122) Usual Care (n = 114)
    Baseline6 moChange %Baseline6 moChange %Difference in Change Between Arms, %P ValueAdjustedaDifferenceAdjustedP Valuea
    Primary and secondary
      HbA1c, mean (SD), %10.05 (2.0)8.98 (2.0)−1.07 (2.8)9.85 (2.0)9.55 (2.3)−0.30 (3.1)−0.77.01−0.69.01
      HbA1c <7.5%, No. (%)5 (4.1)27 (22.0)17.97 (6.1)17 (14.9)8.89.1.11–.04
      Decrease in HbA1c ≥1.0%, No. (%)NA60 (49.6)NANA34 (31.5)NA18.1.005–.001
    Additional markers
      LDL-C,b mean (SD), mg/dL94.8 (30.7)90.9 (27.8)−3.9 (41.4)96.7 (37.1)93.7 (37.4)−3.0 (52.7)–0.9.83–2.0.60
      SBP,c mean (SD), mm Hg142.8 (23.1)144.2 (20.1)1.4 (22.3)144.0 (23.2)139.7 (24.1)−4.3 (26.0)5.7.063.4.19
      BMI,c mean (SD), kg/m235.1 (8.3)35.0 (8.2)−0.1 (1.85)32.9 (8.8)32.8 (8.6)−0.1 (1.4)–0.0.97–0.1.65
    • BMI = body mass index; HbA1c, = glycated hemoglobin; LDL-C = low-density lipoprotein cholesterol; NA = not applicable ;; SBP = systolic blood pressure.

    • ↵a Adjusted for baseline differences in age, marital status, work status, use of insulin, hypertension, and BMI.

    • ↵b Health coaching, n = 107; usual care, n = 96.

    • ↵c Health coaching, n = 128; usual care, n = 123.

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  • The Article in Brief

    Impact of Peer Health Coaching on Glycemic Control in Low-Income Patients With Diabetes: A Randomized Controlled Trial

    David H. Thom , and colleagues

    Background Many primary care practices have no one available to provide the time-consuming counseling and teaching of self-management skills that have been shown to improve diabetes. Peer educators and coaches are trained patient volunteers who themselves have diabetes and can provide ongoing support for self-management to a small group of clients. This study tests the impact of individual peer coaching on glucose control for patients with poorly controlled diabetes seen in public clinics.

    What This Study Found Clinic-based peer health coaching improves the glycemic control of patients with poorly controlled diabetes seen in urban public health clinics. A randomized controlled trial involving almost 300 low-income patients with poorly controlled type 2 diabetes found patients who receive one-on-one coaching and self-management support from volunteer peer coaches saw a greater reduction in HbA1c levels than those in the usual care arm at 6 months' follow-up. HbA1c levels decreased 1 percent or more in 50 percent of coached patients vs 32 percent of usual care patients, and levels at 6 months were less than 7.5 percent for 22 percent of coached vs 15 percent of usual care patients. The authors note that because peer coaches experience similar challenges of living with the same chronic condition as the patients they assist, they are uniquely poised to engage and motivate them in self-management.

    Implications

    • Peer coaches represent a potential resource to increase primary care capacity and remove some of the burdens of patient-self management support from primary care clinicians and staff.
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The Annals of Family Medicine: 11 (2)
The Annals of Family Medicine: 11 (2)
Vol. 11, Issue 2
March/April 2013
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Impact of Peer Health Coaching on Glycemic Control in Low-Income Patients With Diabetes: A Randomized Controlled Trial
David H. Thom, Amireh Ghorob, Danielle Hessler, Diana De Vore, Ellen Chen, Thomas A. Bodenheimer
The Annals of Family Medicine Mar 2013, 11 (2) 137-144; DOI: 10.1370/afm.1443

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Impact of Peer Health Coaching on Glycemic Control in Low-Income Patients With Diabetes: A Randomized Controlled Trial
David H. Thom, Amireh Ghorob, Danielle Hessler, Diana De Vore, Ellen Chen, Thomas A. Bodenheimer
The Annals of Family Medicine Mar 2013, 11 (2) 137-144; DOI: 10.1370/afm.1443
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