Effectiveness of peer support for improving glycaemic control in patients with type 2 diabetes: a meta-analysis of randomized controlled trials

BACKGROUND To assess the effects of peer support at improving glycemic control in patients with type 2 diabetes. METHODS Relevant electronic databases were sought for this investigation up to Dec 2014. Randomized controlled trials involving patients with type 2 diabetes that evaluated the effect of peer support on glycated hemoglobin (HbA1c) concentrations were included. The pooled mean differences (MD) between intervention and control groups with 95% confidence interval (CI) were calculated using random-effects model. The Cochrane Collaboration's tool was used to assess the risk of bias. RESULTS Thirteen randomized controlled trials met the inclusion criteria. Peer support resulted in a significant reduction in HbA1c (MD -0.57 [95% CI: -0.78 to -0.36]). Programs with moderate or high frequency of contact showed a significant reduction in HbA1c levels (MD -0.52 [95% CI: -0.60 to -0.44] and -0.75 [95% CI: -1.21 to -0.29], respectively), whereas programs with low frequency of contact showed no significant reduction (MD -0.32 [95% CI: -0.74 to 0.09]). The reduction in HbA1c were greater among patients with a baseline HbA1c ≥ 8.5% (MD -0.78 [95% CI: -1.06 to -0.51]) and between 7.5 ~ 8.5% (MD -0.76 [95% CI: -1.05 to -0.47]), than patients with HbA1c < 7.5% (MD -0.08 [95% CI: -0.32 to 0.16]). CONCLUSIONS Peer support had a significant impact on HbA1c levels among patients with type 2 diabetes. Priority should be given to programs with moderate or high frequency of contact for target patients with poor glycemic control rather than programs with low frequency of contact that target the overall population of patients.