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Peer support - the missing piece in diabetes care
Midhun Vazhayil, Mayfield Education Incorporated and Ambulatory Care Diabetes, Northern Health; Ashley H. Ng, Monash Centre for Health Research and Implementation and Primary Care Diabetes Society of Australia; Giovanna Taverna, Diabetes Victoria; Rajna Ogrin, Bolton Clarke and Primary Care Diabetes Society of Australia
Source: APNA Primary Times Summer 2024-5
A diabetes diagnosis is a life-changing event for many people, and it can be an isolating experience. Peer support is an underutilised support mechanism for people living with diabetes. It can help people adjust to the condition and thrive. In this article, we explore models of peer support for people living with diabetes, current evidence and the role of healthcare professionals in promoting peer support networks.
Living with diabetes: Impact beyond numbers
Type 1 diabetes (T1D) and type 2 diabetes (T2D) prevalence is increasing globally.1 In Australia, 314 people are added to the national diabetes register each day; of these registrants, 87% have T2D, 9% have T1D and the remaining have gestational diabetes or other types of diabetes.2 In addition to taking medication, lifestyle behaviour considerations, regular glucose monitoring and annual diabetes complication screening, living with diabetes carries a heavy emotional and mental burden on both the person living with diabetes and those who are supporting them. From 2,342 participants in the Diabetes Miles 2 Survey conducted in 2016,3 24% of respondents with T1D experienced severe diabetes distress, as compared to 20% and 11% of those with insulin-managed and non-insulin-managed T2D, respectively. Additionally, people with diabetes are also more likely to be diagnosed with a mental health condition, such as depression, anxiety, fear of hypoglycaemia, psychological barriers to insulin use and eating disorders.4
Given the emotional toll in addition to the physical management diabetes incurs, a multidisciplinary team-based approach is critical to ensuring holistic care for optimal diabetes management to improve clinical outcomes and quality of life.5
Diabetes care: A holistic approach
While healthcare professionals bring clinical expertise, it is important to note that people with diabetes typically spend only about three hours per year in direct clinical contact.6 For the rest of the time, they manage and support themselves, making them experts in their lived experience.6 A person-centred approach proposes that individuals work in partnership with healthcare professionals to make evidence-based decisions towards shared health goals, including diabetes outcomes.7
Traditionally, diabetes care has focused on clinical management of the condition, such as medication management. Support with behavioural and lifestyle change has been increasingly recognised as important.8 However, many people with diabetes face additional psychosocial barriers to sustaining those changes.9 In particular, young adults undergoing significant life changes tend to displace diabetes care as a priority,10 while in older adults, multimorbidity,11 loneliness and social isolation play a significant role impacting on health and wellbeing.12 Another issue that needs to be considered is access to appropriate care and supports for those living in regional and rural areas.13
The power of ‘me too’
Diabetes peer-support groups are one way to ensure that people affected by diabetes are well supported in their journey by those who understand what they are going through due to their own lived experience.14 Peer support is also a hub for learning, where people receive new knowledge through shared experiences.15
There are many peer-support approaches and models (see Figures 1 and 2) and offering a variety of options is crucial in providing effective support to those participating in peer-support programs.18 Each can be complementary to the knowledge, expertise and support a person receives, in addition to the information delivered by health professionals and consumer support organisations. Given the chronic nature of diabetes, peer-support programs provide an avenue of long-term support that can help individuals navigate complex healthcare systems and identify available resources in their local area. Peer support also provides much needed social and emotional support and helps peers cope with negative emotions through empathetic listening and encouragement.16 It can also offer support and troubleshooting advice for non-emergency diabetes-related questions between clinical appointments, such as tips on how to share glucose data with a healthcare professional before an appointment.
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Figure 1: Peer support can occur in different ways, with pros and cons for each option.16 |
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Figure 2: Peer support is not one size fits all. Different models of peer support will suit different individuals.17
Peer support: Fad and facts
Peer support has been shown to improve biomedical markers of diabetes, such as mean reduction of HbA1c19,20 and blood pressure.21 However, peer-support groups act as additional support networks promoting psychosocial well-being, helping people living with diabetes keep motivated and reinforcing positive health behaviours16; therefore HbA1C alone may not be the appropriate indicator to assess their effectiveness. Peer support groups also promote positive impacts on HbA1C in culturally and linguistically diverse (CALD), structurally disadvantaged, disengaged and lower health-literacy groups20,22. Online peer-support groups, such as diabetes online communities, are cost-effective, easy to moderate and convenient as they can be accessed after office hours. Due to the diversity of people within these groups, online communities are often effective at self-regulating credibility of information being shared.23 While there are potential pitfalls, as outlined in the box above, this highlights the importance for health professionals to discuss the knowledge and skills participants have gained through peer-support groups to ensure the participants are accessing appropriate information. When in doubt, clinicians or practices can choose to contact the administrators running the peer-support groups at their discretion, to identify how the information is monitored in those groups.
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Potential pitfalls of online peer support
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Diabetes peer support in Australia
Australia has many peer-support opportunities and activities in operation, as shown in the box below. The National Diabetes Service Scheme (NDSS) website informs clinicians about the peer-supported programs under various streams in their practice area and provides information on available diabetes online communities.
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Peer support offerings in Australia State/territory-based diabetes organisations may offer:
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How can healthcare professionals support people with diabetes?
Integrating peer support into the care plans of people living with diabetes can significantly enhance the support these individuals receive. Mentioning peer support during consultations and being familiar with local networks can create a more comprehensive care plan. This approach provides emotional and social support to people living with diabetes and helps healthcare providers stay informed on the latest trends in diabetes management, which can also aid in recredentialling.
A common challenge is finding convenors for peer-support groups, particularly in underserved communities. Healthcare professionals can play a crucial role in facilitating this. For those interested in a more active role (see box below), convening or co-convening a peer-support group can be incredibly rewarding and vital for the sustainability of these networks. These groups offer spaces for evidence-based discussions, emotional support, and shared experiences, benefiting all participants. Healthcare professionals can ensure these groups meet regularly and remain effective by listening to participant feedback.
Being involved in peer support enriches both the care for people living with diabetes and professional practice, creating a supportive community for those managing diabetes. Being open and listening to the experiences of people living with diabetes during the clinical consults will allow healthcare professionals to understand the effectiveness of these programs and communicate with peer leaders if any changes are required.
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What can healthcare professionals do to promote peer support for people living with diabetes?
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Conclusion
Healthcare professionals must address not only the medical aspects of diabetes care but also the psychosocial challenges faced by those living with the condition. Peer support, often underutilised, offers invaluable support from individuals with lived experiences. Promoting peer support can significantly enhance holistic, person-centred care.
These communities will continue to grow with or without professional involvement. As healthcare professionals, it is our responsibility to stay informed, connect with, and support these networks. Start by exploring local resources, building relationships with peer-support groups and integrating them into the care plan of people living with diabetes in your care. For those interested in convening a peer-support group, connect with your state/territory diabetes organisations to find out how.
Your involvement could make a significant difference, fostering stronger, more connected communities for those affected by diabetes.
Diabetes Victoria
Diabetes Victoria is dedicated to reducing the impact of all types of
diabetes on people, families, communities and health systems across our state. We support, empower and campaign for all Victorians living with, affected by, or at risk of, diabetes. Visit www.diabetesvic.org.au to find out more.
Primary Care Diabetes Society of Australia
The mission of the Society is to support primary care health professionals to deliver high-quality clinically effective care, in order to improve the lives of people living with diabetes. For more information, please visit www.pcdsa.com.au.
References
1. KL Ong, LK Stafford, SA McLaughlin et al., 'Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021', Lancet, 2023, 402(10397):203–234.
2. National Diabetes Service Scheme (NDSS), Diabetes data snapshots, NDSS website, 31 March 2024, accessed 16 September 2024.
3. AD Ventura, E Holmes-Truscott, C Hendrieckx, F Pouwer and J Speight, Diabetes MILES-2 2016 Survey Report, Diabetes Victoria, Melbourne, 2016.
4. C Hendrieckx, JA Halliday, LJ Beeney and J Speight, Diabetes and emotional health: a practical guide for health professionals supporting adults with type 1 or type 2 diabetes, National Diabetes Services Scheme, Canberra, 2020.
5. Royal Australian College of General Practitioners (RACGP), Management of type 2 diabetes: a handbook for general practice, RACGP, Melbourne, 2020.
6. EB Fisher, RI Boothroyd, MM Coufal et al., 'Peer support for self-management of diabetes improved outcomes in international settings', Health Aff, 2012, 31(1):130–139.
7. S Tamhane, R Rodriguez-Gutierrez, I Hargraves and VM Montori, 'Shared decision-making in diabetes care', Curr Diab Rep, 2015, 15(12):112.
8. J McSharry, M Byrne, B Casey et al., 'Behaviour change in diabetes: behavioural science advancements to support the use of theory', Diabet Med, 2020, 37(3):455–463.
9. PPS Lekha and EPA Azeez, 'Psychosocial facilitators and barriers to type 2 diabetes management in adults: a meta-synthesis', Curr Diabetes Rev, 2024, 20(8):110–123.
10. AH Ng, ML Pedersen, B Rasmussen and MJ Rothmann, 'Needs of young adults with type 1 diabetes during life transitions - an Australian–Danish experience', Patient Educ Couns, 2022, 105(5):1338–1341.
11. J Pearson-Stuttard, J Buckley, M Cicek and EW Gregg, 'The changing nature of mortality and morbidity in patients with diabetes', Endocrinol Metab Clin North Am, 2021, 50(3):357–368.
12. E Halcomb, C Thompson, S Tillott, K Robinson and E Lucas, 'Exploring social connectedness in older Australians with chronic conditions: results of a descriptive survey', Collegian, 2022, 29(6):860–866.
13. G Siopis, A Jones and M Allman-Farinelli, 'The dietetic workforce distribution geographic atlas provides insight into the inequitable access for dietetic services for people with type 2 diabetes in Australia', Nutr Diet, 2020, 77(1):121–130.
14. Z Aziz, MA Riddell, P Absetz et al., 'Peer support to improve diabetes care: an implementation evaluation of the Australasian Peers for Progress Diabetes Program', BMC Public Health, 2018, 18(1):262.
15. RI Boothroyd and EB Fisher, 'Peers for progress: promoting peer support for health around the world', Family Practice, 2010, 27 Suppl 1:i62–68.
16. H Warshaw, L Hodgson, M Heyman et al., 'The role and value of ongoing and peer support in diabetes care and education', Diabetes Educator, 2019, 45(6):569–579.
17. S Lu, N Leduc and G Moullec, 'Type 2 diabetes peer support interventions as a complement to primary care settings in high-income nations: a scoping review', Patient Educ Couns, 2022, 105(11):3267–3278.
18. C Jones, K Hider, K Hassard and J Speight, 'Peer support in Australia: empowering people to live well with diabetes', Connect, 2017;20(4).
19. A Azmiardi, B Murti, RP Febrinasari and DG Tamtomo, 'The effect of peer support in diabetes self-management education on glycemic control in patients with type 2 diabetes: a systematic review and meta-analysis', Epidemiol Health, 2021, 43:e2021090.
20. SJ Patil, T Ruppar, RJ Koopman et al., 'Peer support interventions for adults with diabetes: a meta-analysis of hemoglobin a(1c) outcomes', Ann Fam Med, 2016, 14(6):540–551.
21. I Verma, V Gopaldasani, V Jain et al., 'The impact of peer coach-led type 2 diabetes mellitus interventions on glycaemic control and self-management outcomes: a systematic review and meta-analysis', Prim Care Diabetes, 2022, 16(6):719–735.
22. X Zhang, S Yang, K Sun, EB Fisher and X Sun, 'How to achieve better effect of peer support among adults with type 2 diabetes: a meta-analysis of randomized clinical trials', Patient Educ Couns, 2016, 99(2):186–197.
23. ML Litchman, HR Walker, AH Ng et al., 'State of the science: a scoping review and gap analysis of diabetes online communities', J Diabetes Sci Technol, 2019, 13(3):466–492.
