Peer-Led Diabetes Self-Management Program for Patients With Glycated Hemoglobin Values Greater Than 7%
INTRODUCTION: Type II diabetes mellitus is the 7th leading cause of death in Kalamazoo County. Glycated hemoglobin (HbA1c) is a biomarker used to evaluate blood glucose control spanning a 3-month period; a value >7% indicates poorly controlled diabetes over the past 3 months. PURPOSE: To determine the effectiveness of a free diabetes self-management program when implemented in Kalamazoo County. METHODS: Nineteen individuals (5 males, 14 females, average age 58 years, range 39 to 82 years) with type II diabetes mellitus and a self-reported HbA1c >7% enrolled in the study. These individuals began a 6-week diabetes self-management program, during which participants met in small groups for 2.5 hours each week. The focus of this program was for participants to build skills that enabled them to better manage their chronic disease by improving problem solving, nutrition, blood glucose monitoring, and working with healthcare providers. HbA1c values were obtained via medical records prior to program completion (baseline) and 3-months post-program. Surveys that evaluated subjective information were also obtained at baseline and 3-months post-program. RESULTS: Nearly 950 members of the Kalamazoo community with type II diabetes mellitus were contacted to participate in this free self-management program. Recruitment was a challenge as only 99 verbally agreed they would attend the program, of which 48 attended the first session and 19 of those enrolled in the study. Five participants were excluded due to medical-record-documented HbA1c values <7%, 6 did not complete the program, and 1 was lost to follow-up. Of the 7 participants who completed their 3-month follow-up, most variables exhibited desirable trends from baseline to 3-months post-program, and those that remained unchanged were already within a desirable range at baseline. The variables closest to significance were an increase in median self-efficacy score (49 to 78 using a 0-80 scale, p = 0.062) and a decrease in median HbA1c (10.2% to 8.5%, p = 0.31). DISCUSSION: Despite limited statistical power due to small sample size, this program provided valuable education to many community members who may be considered underserved and have HbA1c values as high as 14%. Future work is needed to analyze the healthcare barriers these individuals endure and how they may be overcome. Facilitation of healthcare provider referral to the program may be an option that encourages both participant adherence and expansion of this low-cost diabetes education model throughout the community.