Peer coaches to improve type 2 diabetes mellitus outcomes through patient activation and self-management in India

Background: Type 2 diabetes mellitus (T2DM) stands as a significant public health concern, not only in India but globally, ranking among leading non-communicable diseases with high mortality rates. Effectively managing T2DM requires the adoption of crucial self-management behaviors, encompassing medication adherence, a healthy diet, blood glucose monitoring, regular physical activity, and footcare. Recognizing the pivotal role of self-management in controlling T2DM, the concept of patient activation has been introduced to empower individuals in taking charge of their health. Patients with higher levels of activation demonstrate a greater propensity for engaging in self-care behaviors, achieving improved clinical outcomes, and incurring lower healthcare costs. In tandem with patient activation, peer coaches have emerged as valuable assets in providing support to individuals managing diabetes. The collaborative synergy between patient activation and peer coaching holds considerable potential for optimizing T2DM management. Despite the global significance of these strategies, there is limited information about the impact of patient activation driven diabetes self-management interventions delivered by peer coaches, specifically in the context of Indian hospital settings. This study was an attempt to fill this knowledge gap.

Methodology: This was a mixed-methods study, conducted in three phases across nine government hospitals in New Delhi, India. Phase I was a cross-sectional study which included a large cohort of diabetes patients. Phase II assessed the effect of patient activation driven diabetes self-management intervention delivered by peer coaches. Phase III was a qualitative study, which explored the feasibility, acceptability and sustainability of the self-management intervention. Data for Phases I and II were collected using self-administered questionnaires. Data for Phase III were collected using semi-structured interviews.

Results: Phase I involved 326 patients living with T2DM in New Delhi, India. Results revealed the majority of participants were females aged 45–65 years of age. Over half were low educated, had caregivers and were mainly relatives. Clinical data analyses showed that more than half had uncontrolled HbA1c level and the majority of participants were either obese or overweight. In terms of patient activation, almost half of the participants were at level 1 (not activated), one third were at level 2 (low activated) and about a quarter were at level 3 (highly activated). In relation to self-management, participants showed a moderate adherence to healthy diet and exercise; however, they struggled in managing blood sugar testing and footcare. Regression analyses revealed that diabetes self-management behaviors were significant predictors of diabetes clinical data. Similarly, patient activation was a significant predictor of self-management behaviors. Phase II involved examining the impact of patient activation driven intervention delivered by peer coaches among 65 individuals living with T2DM. It showed substantial improvements in glycemic control, exercise and diet self-management behaviors. However, marginal progress was observed in blood sugar testing, footcare and medication adherence. Phase III, post-intervention interviews with patients, doctors and peer coaches, showed they found the intervention feasible, acceptable and sustainable.

Conclusion: This study significantly contributes to the existing body of evidence supporting the effectiveness of self-management interventions and the pivotal role of peer support in enhancing diabetes care. Our finding showed that patient activation can be used as a reliable driver of diabetes self-management. In the same vein, our data revealed that peer coaches can offer reliable support of diabetes care in community settings. Peer coaches played instrumental roles in supporting and empowering participants to actively engage in diabetes care which highlighted the potential of peer support interventions. Participating patients, doctors and peer coaches highlighted the viability and acceptability of the intervention and its potential for broader implementation. Moving forward, these findings suggest that interventions emphasizing patient activation and peer coaching could be instrumental in shaping the future landscape of diabetes care in India and in similar healthcare settings.