Lay Volunteers Can Play Pivotal Role in Diabetes Management

SAN DIEGO—A community-based program that trains lay volunteers with diabetes to teach their fellow diabetics about diabetes self-management and help them devise an individual management plan appears to be paying off, according to data reported at the 71st Scientific Sessions of the American Diabetes Association.

Results at two years show that the program, known as the Diabetes Network of St. Louis, boosts behavioral and clinical outcomes in its target population of underserved diabetic patients.

“We believe that these improvements are largely attributable to self-management behaviors rather than physician-directed therapy,” said Garry Tobin, MD, Associate Professor of Medicine at Washington University School of Medicine and Director of the Diabetes Center at Barnes-Jewish Hospital in St. Louis.

The program was launched in 2008 following a report by the St. Louis Diabetes Coalition citing limitations in the care of diabetics residing in the greater St. Louis area. The report noted, for example, that hospitals manage most of the structured diabetes education programs in the region and that these programs were not sufficient to satisfy demand.  The report also mentioned barriers to access to hospital-based programs including location, referral patterns, and fees, thereby making self- management education inaccessible for most diabetic patients.

With the lay-led diabetes program, unpaid volunteers undergo 25 to 30 hours of training after which they lead support groups which focus on glucose monitoring, complications, foot care, medications, diet and exercise, and community resources. Thus far, most of the lay leaders have been recruited from Dr. Tobin's clinical practice.

Sessions are held at churches, libraries, senior living facilities, and occasionally at health clinics in the communities where diabetic patients in need of services reside. Groups meet every other week for sessions that typically last 1.5 to 2 hours.

Overall, 26 lay leaders and more than 400 individuals with diabetes (mostly type 2 diabetes) have participated in the program at 34 community sites. Participants attended a mean of 2.8 of six possible sessions, and more than half attended at least half of the sessions.

Results indicate that the average number of days per week that participants followed a recommended eating plan increased from 2.6 days at baseline to 3.5 days, and the number of days per week that participants consumed five or more fruits or vegetables increased from 3.5 days to 4.1 days. Participants initially exercised 3.0 times a week, which increased to 3.5 times per week. In addition, the frequency of blood glucose monitoring increased from 3.5 to 4.7 times a week.

Hemoglobin A1C (HbA1c) level decreased from 7.40% at baseline to 7.19%.  Body mass index decreased from 34 to 33.7 kg/m2, systolic blood pressure (BP) from 141.3 to 137.5 mm Hg, and diastolic BP from 78.3 to 76.1 mm Hg.   

Dr. Tobin emphasized that the ideal lay leader is not necessarily the patient who would be considered successful by conventional measurable criteria. “I have one patient whom I chose [to be a lay leader] because she is highly knowledgeable and vivacious but she has not been able to take her knowledge and apply it to herself and has not been able to lower her HbA1C level from 10 to 12%,” he said. “So you don't necessarily need a lay leader with the best HbA1C and you actually want someone who is not quite so perfect and can say ‘I screwed up.'”

“This is AA [Alcoholics Anonymous] for diabetics,” co-investigator Eric Armbrecht, PhD, Assistant Professor of Medicine at Saint Louis University School of Medicine and Executive Director of the St. Louis Diabetes Coalition, added. “The AA model of addiction support is successful because it is sustainable due to its provision of services at low cost,” he said. “Our approach of using lay, unpaid trained volunteers to implement self-management support helps us provide a sustainable, cost-effective solution to the diabetes epidemic without relying exclusively on health professionals in an already near-bankrupt health care system.”

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