Improving Diabetes Control Through Peer Counseling and Incentives

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.

A peer counselor will be assigned to each participant who currently has good diabetes control but had poor control in the past 3 years.

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.

Participants will be given $100 for reduction of HbA1c by 1 point in a 6 month period and $200 for reduction by 2 points.

All events and serious events related to hypoglycemia will be counted over the 6 month intervention period, including emergency room visits and hospitalizations.

The experience of peer counseling from both poorly controlled diabetics and counselors will be described.

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

Long JA, Jahnle EC, Richardson DM, Loewenstein G, Volpp KG. Peer mentoring and financial incentives to improve glucose control in African American veterans: a randomized trial. Ann Intern Med. 2012 Mar 20;156(6):416-24. doi: 10.7326/0003-4819-156-6-201203200-00004.

This research was supported by a grant from the National Institute on Aging, P30-AG036592. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Aging or the NIH