Improving Diabetes Control Through Peer Counseling and Incentives

Study Overview
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Brief Summary
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The specific aims of this study are to test whether in a cohort of low-income minority veterans with poor diabetes mellitus (DM) control: Peer counseling is an effective means of reducing HbA1c (a measure of glucose control). Financial incentives are an effective means of reducing HbA1c. This is a randomized controlled pilot study. There will be 3 arms: 1) a control group of poorly controlled diabetics getting usual care; 2) peer counseling with no incentives; and 3) financial incentives without peers. Ultimately, contingent on the success of this intervention, the researchers plan to apply for funding for a large scale intervention employing both peer counseling and incentives to improve DM control in low income and minority patients who are at high risk for premature morbidity and mortality.

Official Title
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Improving Diabetes Control Through Peer Counseling and Incentives

Conditions
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Diabetes Mellitus

Intervention / Treatment
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* Behavioral: Assigned a peer counselor
* Behavioral: Financial incentives


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: African American veteran 50-70 years old ICD-9CM diagnosis code consistent with DM (any ICD-9CM code starting with 250) For patients: last two HbA1c greater than 8% with at least one measure being within 3 months of enrollment For peer counselors: HbA1c of greater than 8% in the past 3 years and an HbA1c less than or equal to 7.5% within 3 months of enrollment Exclusion Criteria: Unstable medical condition that would likely prevent the subject from completing the study Patients enrolled in Telehealth will be excluded as such enrollment does not constitute usual care

Ages Eligible for Study
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Minimum Age: 50 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control<br>This group will receive usual diabetes care through their primary care clinicians. | |
| Experimental: Peer counseling<br>A peer counselor will be assigned to each participant who currently has good diabetes control but had poor control in the past 3 years. | Behavioral: Assigned a peer counselor<br>* Dyads will be given $20 per month if they have contact 4 or more times during a month.<br>|
| Experimental: Financial incentives<br>Patient participants in the financial incentive arm will be given $100 for reduction of HbA1c by 1 point in a 6 month period and $200 for reduction by 2 points. | Behavioral: Financial incentives<br>* Participants will be given $100 for reduction of HbA1c by 1 point in a 6 month period and $200 for reduction by 2 points.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hemoglobin A1c | Change in HbA1c from baseline will be the primary outcome measure. | Baseline, 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Counts of the number of hypoglycemic events | All events and serious events related to hypoglycemia will be counted over the 6 month intervention period, including emergency room visits and hospitalizations. | 6 months | 
| Number of peer encounters | The number of peer encounters by arm will be described. | 6 months | 
| Experience of peer counseling | The experience of peer counseling from both poorly controlled diabetics and counselors will be described. | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Diabetes, Diabetes mellitus, HbA1c