Please select the eligibility criteria that correspond to the clinical trial below.
Title: Peer Support, Empowerment and Remote Communication Linked by Information Technology (PEARL): A Multi-Component Program to Improve Community-Based Diabetes Care
Brief Summary: Quality diabetes care requires informed-decisions of motivated care providers and diabetes patients. The investigators aim to use peer support and information technology to facilitate care providers to implement structured care and empower diabetes patients acquire self-management skills in a multi-component program.

The investigators will make use of the following tools: (1) The Joint Asia Diabetes Evaluation (JADE) Program. JADE Program uses a web-based electronic portal to establish a registry and stratify diabetes patients to care protocols based on their risk profiles with features of decision support and data management. (2) The Australasian Telephone Linked Care (TLC) system. TLC system utilizes an automatic, interactive, computer-controlled telephone system to monitor and promote diabetes self-management.

Amongst 600 diabetes patients receiving structured care in Hong Kong through the JADE Program, half of them will be randomized to receive peer support (n=300) including personal coaching by 30 trained mentors (1 mentor to 10 diabetes patients or mentees) through regular phone calls and sharing sessions, and the other half (n=300) will continue the usual diabetes care in their clinic. The 30 mentors are themselves diabetes patients who have good self care and are motivated to support their peers. The mentors will be trained to deliver peer support intervention under supervision by a program manager. The 300 diabetes patients (mentees) randomized to the peer support group are the intervention targets of these 30 mentors. They will be reminded to use the TLC for knowledge enhancement and motivational support.

The investigators will analyse the changes in risk factor control (blood glucose parameters, blood pressure, body weight, lipids), quality of life and cognitive-psychological-behavioral parameters after 12 months. Effects of various components of peer support on these outcomes as well as user acceptability and cost-effectiveness of these programs will be examined.

The investigators will test the hypothesis that in a multi-component program, the use of a peer support program delivered by diabetes patient-mentors, to influence and motivate other diabetes patients receiving structured care made possible through a web-based disease management program, delivered by a doctor-nurse team, will further improve metabolic control, QOL and self care compared to diabetes patients receiving the same standard of care.


Options:
A: Inclusion Criteria:

(The unit of randomization is the medical clinic)

* Clinics were excluded if they participated in an effective quality improvement program within the last two years.
* Clinics must have 3-22 full time equivalent providers
* Clinics must be located in Minnesota or Western Wisconsin
* Clinics must be willing to implement a diabetes registry
* Must be a single specialty, general internal medicine or family practice clinic
B: Inclusion Criteria:

* adult (18-70 years);
* enrolled to receive mental health treatment at Harborview Mental Health Services or Downtown Emergency Services Mental Health center
* a diagnosis of type 2 diabetes mellitus or cardiovascular disease
* Hemoglobin A1c \>8 or BP \> 140/90

Exclusion Criteria:

* cognitive, hearing, or language impairment that would preclude a subject from providing informed consent;
* current suicidality, homicidality, or grave disability that requires psychiatric hospitalization;
* current substance abuse or dependence, as defined by SCID.
C: Inclusion Criteria:

* 1) Type 2 diabetic patients with medium or moderate risk for complications (stratified by JADE Program, Care Levels 2 to 4) and followed up 3-4 monthly according to the JADE Program. Based on our 6000-patient registry, these risk levels clearly separate diabetes patients based on risk of future clinical events.
* 2) Men/women aged 18-70 years (inclusive), functionally independent and with informed written consent.

Exclusion Criteria:

* 1) Patients with one or no risk factors (low risk, Care Level 1 by JADE Program) as stratified by the JADE Risk Engine.

  2) Patients with reduced life expectancy and unstable mood or major psychiatric conditions.

  3) Patients who cannot communicate in Chinese language.
D: Inclusion Criteria:

* Diagnosis of diabetes and hypertension
* HgA1C value greater than or equal to 7.5
* Creatinine value less than or equal to 2.0mg/dl
* SBP greater than or equal to 140

Exclusion Criteria:

* Prior diagnoses of dementia using ICD-9 codes validated for a VA population

Answer: C