The prevalence of diabetes among adults has become a public health problem. Between 1980 and the year 2011, the prevalence of diabetes rose by an alarming figure from 5.5 million to 19.6 million (Haas, et al., 2013). This in essence means that the channels that have been put in place over those few years to combat diabetes prevalence and its rise across all age groups have not effectively achieved the intended objectives. Prevalence of diabetes has been higher among the older population beyond 45 years of age and has been extremely prevalence within the adult group aged 65 years and above (Haas, et al., 2013). This signals not only a lack of proper resources and channel to deal with obesity but more so the existence of knowledge gap in matters pertaining the management and control of diabetes (Tuomilehto et al., 2001).
Tang et al. (2014), in their study sought to explore the influence of peer leaders comparative to that of the community health workers in helping diabetic patient in self-management of their condition. Essentially, the study sought to explore the effectiveness of two interventions; one guided by peer leaders in a program dubbed the diabetes self-management education and secondly the effectiveness of community health workers programs in the DSME. The blood glucose levels (HbA1c) was the primary outcome for both program while on the other hand secondary outcomes included the risk factors for cardiovascular diseases, social support for diabetes and diabetes distress (Tang et al., 2014).
The study had a population sample of 116 adults of the Latino origin who were all randomly recruited from federal health centers and who had been diagnosed with diabetes. The DSME program in both the Peer leader (PLs) led intervention and the Community health workers (CHWs) led group had two major sessions (Tang et al., 2014). The entire program stretched to 18 months with the first session comprising of the DSME program and the second session of 12 months entailing group sessions on a weekly basis guided by PLs and for those unable to attend, a telephone outreach was applied while in the CHW group the second session included telephone outreach on a monthly basis delivered by the CHW in charge of each group. Assessment for the primary and secondary outcomes was done by comparing with baseline data at the 6th, 12th and 18th months (Tang et al., 2014).
The outcomes of the study indicated that for the PL group, there was a mean reduction of HbA1c by between 66–58 mmol/mol (8.2%-7.5%) a figure was maintained all the way to the 18th month from baseline (−6.6 mmol/mol) (Tang et al., 2014). The CHW group on the other hand indicated a reduction in HbA1c from baseline at 62 vs. 56 mmol/ mol (7.8 vs. 7.3%) but this value was reduced towards the end of the program at the 18th month by −3.3 mmol/mol (Tang et al., 2014). A comparative analysis indicated that the PL group was able to maintain the improvements in blood pressure even at the 18th month. Follow up at the 18th month indicated that diabetes support, waist circumference, diabetes distress indicated significant improvement in both groups with minimal differences (Tang et al., 2014).
This study indicated that while both low cost programs (both PL and CHW) had a significant impact on the blood glucose levels of the patients indicating a positive impact on the general health of diabetic patients. The PLs and the CHWs focused on behavioral modification education and strategies, utilization of available, self-management challenges and strategies for achieving the same, motivational aspects to deal with diabetes distress and the aspect of diet management among others (Tang et al., 2014). On the other hand, the programs incorporated the aspects of social support for the diabetic patients which have been proved to have a massive impact on the social development of diabetic patients.
However, the most important elements picked from the study are based on the role of the PLs and the CHWs in helping patients adopt effective self-management strategies. The closer association between the PL and the respective groups falling under their category can be attributed for the positive impacts that were achieved at the end of the 18th month especially on the aspects of blood glucose levels (Norris et al., 2002). While the CHWs had time with their patients, the differences in length of time between one interaction with the patients and the next could have caused the difference documented across the blood glucose levels of the PL and CHW group.
In essence the support frequency offered by the PLs was at a higher level than that offered by the CHWs which in the very end proved to be significant. This information provides an idea that beyond the availability and utilization of similar resources for self-management for diabetic patients. The availability of social support is a key aspect of the diabetic management program (Haas, et al., 2013). These ideologies are important for nurses handling patients with diabetes in that it enables open up the idea of close and frequent follow-up channels to continually offer the patient not just the knowledge and skill necessary for self-management but also to offer social support for these patients (Norris et al., 2002). Diabetes distress is a risk factor for advancement to other complications such as cardiovascular illnesses and through frequent social support from the nurse, the family and the community (Tuomilehto et al., 2001).
Haas, L., Maryniuk, M., Beck, J., Cox, C. E., Duker, P., Edwards, L., & Youssef, G. (2013). National standards for diabetes self-management education and support. Diabetes care, 36(Supplement 1), S100-S108.
Norris, S. L., Lau, J., Smith, S. J., Schmid, C. H., & Engelgau, M. M. (2002). Self-Management education for adults with type 2 Diabetes A meta-analysis of the effect on glycemic control. Diabetes care, 25(7), 1159-1171.
Tang, T. S., Funnell, M., Sinco, B., Piatt, G., Palmisano, G., Spencer, M. S., & Heisler, M. (2014). Comparative effectiveness of peer leaders and community health workers in diabetes self-management support: results of a randomized controlled trial. Diabetes care, 37(6), 1525-1534.
Tuomilehto, J., Lindström, J., Eriksson, J. G., Valle, T. T., Hämäläinen, H., Ilanne-Parikka, P., & Uusitupa, M. (2001). Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. New England Journal of Medicine, 344(18), 1343-1350.