Peer support in diabetes management -- toward global application. Overview.

In this supplement of Family Medicine are published four background papers and three manuscripts that resulted from the World Health Organization Consultative Conference on Peer to Peer programmes in diabetes held in Geneva on 5–7 November 2007. Additionally, Drs Boothroyd and Fisher have contributed a summary of events that have taken place as a result of that conference, especially the development of the global Peers for Progress programme to promote peer support in diabetes. The consultative conference report in its entirety can be found at http://www.who. int/diabetes/publications /Diabetes_final_13_6. pdf. The global population of people with diabetes is expected to reach 250 million by 2010 and between 300 and 350 million by 2025. This predicted dramatic increase in the number of people with diabetes will demand more health care needs and costs, which will further stress the current dysfunctional health care system. It is not possible to increase the number of physicians, nurses, dieticians and health care facilities in parallel to the diabetes epidemic. Since diabetes has reached now pandemic proportions, the humanitarian consequences in low-income countries will be devastating. This reality explains why the United Nations has passed a resolution that recognizes diabetes as a very serious global threat—the first resolution of this kind for a chronic non-communicable disease (http://www .unitefordiabetes.org/news/campaign/g77_support_a_un _resolution_on_diabetes/). There is a need to find new effective ways to reduce the public health impact of diabetes. Developing an international effort to bring structured and effective peer support to people with diabetes is a promising approach to the immense and growing problem of improving self-management by people with diabetes and reducing subsequent morbidity and mortality. In her background paper entitled Different Models to Mobilize Peer Support to Improve Chronic disease Self-Management and Clinical Outcomes: Evidence, Logistics, Evaluation Considerations, and Needs for Future Research, Dr Michele Heisler notes that interventions that mobilize and build on peer support are an especially promising way to improve selfmanagement support for patients with diabetes. The most effective models appear to combine peer support with a more structured programme of diabetes selfmanagement education (DSME). She concludes that a critical issue for many patients with diabetes is accessing sufficient support on a regular basis for effective diabetes self-management. In the face of growing numbers of older adults with chronic illnesses such as diabetes and significant resource constraints facing health systems worldwide, it is increasingly important to develop and evaluate low-cost interventions that build on available resources and can empower patients to provide greater mutual assistance. Further, she notes that novel strategies are needed to increase between-visit support via community-based programmes, telephone-based programmes and programmes utilizing new communication technologies for the large numbers of patients with limited health literacy and that peer support models may provide this kind of between-visit support as a potentially low-cost flexible supplement to formal health care support. In her background paper entitled Peer-Based Behavioral Strategies to Improve Chronic Disease SelfManagement and Clinical Outcomes: Evidence, Logistics, Evaluation Considerations, and Needs for Future Research Ms Martha M Funnell begins by stating that the diagnosis of a chronic disease such as diabetes generally evokes strong emotions and often brings with it the need to make changes in lifestyle behaviours, such as diet, exercise, medication management and monitoring of clinical and metabolic parameters. This results in the diagnosis affecting not only the person diagnosed but also family members. Chronic illnesses are largely self-managed with >99% of the care becoming the responsibility of patients and their families or others involved in the daily management of their illnesses. While the responsibility for outcomes, such as metabolic control and chronic complications, are shared with the health care team, the daily decisions and behaviours adopted by patients clearly have a strong influence on their future health and well-being. She then goes on to outline behavioral strategies that should be considered in developing peer-based programmes beginning with collaborative