Implementation of a Technology-Enabled Diabetes Self-Management Peer Coaching Intervention for Patients With Poorly Controlled Diabetes: Quasi-Experimental Case Study (Preprint)
Authors: Arévalo Avalos Marvyn R , Patel Ashwin , Duru Haci , Shah Sanjiv , Rivera Madeline , Sorrentino Eleanor , Dy Marika , Sarkar Urmimala , Nguyen Kim H , Lyles Courtney R , Aguilera Adrian 
Published: October 2024

BACKGROUND

Patients with diabetes experience worse health outcomes and greater health care expenditure. Improving diabetes outcomes requires involved self-management. Peer coaching programs can help patients engage in self-management while addressing individual and structural barriers. These peer coaching programs can be scaled with digital platforms to efficiently connect patients with peer supporters who can help with diabetes self-management.

OBJECTIVE

This study aimed to evaluate the implementation of a technology-enabled peer coaching intervention to support diabetes self-management among patients with uncontrolled diabetes.

METHODS

MetroPlusHealth, a predominant Medicaid health maintenance organization based in New York City, partnered with Pyx Health to enroll 300 Medicaid patients with uncontrolled diabetes into its 6-month peer coaching intervention. Pyx Health peer coaches conduct at least 2 evidence-based and goal-oriented coaching sessions per month with their assigned patients. These sessions are focused on addressing both behavioral and social determinants of health (SDoH) with the goal of helping patients increase their diabetes self-management literacy, implement self-management behaviors, and reduce barriers to ongoing self-care. Data analyzed in this study included patient demographic data, clinical data (patient’s hemoglobin A<sub>1c</sub> [HbA<sub>1c</sub>]), and program implementation data including types of behavioral determinants of health and SDoH reported by patients and types of interventions used by peer coaches.

RESULTS

A total of 330 patients enrolled in the peer mentoring program and 2118 patients were considered to be on a waitlist group and used as a comparator. Patients who enrolled in the peer coaching program were older; more likely to be English speakers, female, and African American; and less likely to be White or Asian American or Pacific Islander than those in the waitlist condition, and had similar HbA<sub>1c</sub> laboratory results at baseline (intervention group 10.59 vs waitlist condition 10.62) Patients in the enrolled group had on average a –1.37 point reduction in the HbA<sub>1c</sub> score (n=70; pre: 10.99, post 9.62; <i>P</i><.001), whereas patients in the waitlist group had a –0.16 reduction in the HbA<sub>1c</sub> score (n=207; pre 9.75, post 9.49; <i>P</i><.001). Among a subsample of participants enrolled in the program with at least 2 HbA<sub>1c</sub> scores, we found that endorsement of emotional health issues (β<i>=</i>1.344; <i>P=</i>.04) and medication issues (β<i>=</i>1.36; <i>P=</i>.04) were significantly related to increases in HbA<sub>1c</sub>.

CONCLUSIONS

This analysis of a technology-enabled 1-on-1 peer coaching program showed improved HbA<sub>1c</sub> levels for program participants relative to nonprogram participants. Results suggested participants with emotional stressors and medication management issues had worse outcomes and many preferred to connect through phone calls versus an app. These findings support the effectiveness of digital programs with multimodal approaches that include human support for improving diabetes self-management in a typically marginalized population with significant SDoH barriers.