Peer Support Intervention’s Impact on Glycemic Control Among Type 2 Diabetes Mellitus Patients

Abstrak Beberapa model telah dikembangkan untuk mendukung manajemen mandiri pasien untuk mengontrol glukosa darahnya. Intervensi peer support diyakini berdampak positif pada pengendalian glikemik pada penderita diabetes melitus tipe 2. Tujuan dari tinjauan literatur ini adalah untuk mengidentifikasi efek dari beberapa intervensi peer support pada kontrol glikemik di antara orang dewasa dengan diabetes mellitus tipe 2. Pencarian literartur secara integratif dilakukan di basis data elektronik seperti PubMed, CINALH, dan Cochrane. Kriteria inklusi penelitian yang ada di tinjauan literatur ini adalah penelitian dengan intervensi peer support, menggunakan desain randomized control trial pada pasien dengan diabetes mellitus tipe 2, kontrol glikemik sebagai hasil, menggunakan bahasa Inggris, diterbitkan dalam 10 tahun terakhir, dan tersedia dalam teks lengkap dan gratis. Tujuh penelitian memenuhi kriteria inklusi dan dimasukkan dalam analisis lebih lanjut. Lima studi melaporkan intervensi peer support secara statistik signifikan untuk meningkatkan kontrol glikemik melalui penurunan tingkat HbA1c. Intervensi peer support jangka pendek memberikan manfaat potensial pada kontrol glikemik.


INTRODUCTION
Diabetes mellitus is a chonic disease that need complex and various strategies to control blood sugar level (1). and ability that improve health outcome such as HbA1c, LDL level, and blood pressure level (5). DSME for groups of diabetes patients could be provided by doctors or nurses (6).
However studies reported the outcomes of DSME sustained around 12 months after intervention (7,8) and need adequate health care personnel (9).
In order to assist ongoing self-management in patients with type 2 diabetes mellitus, peer support intervention having potential benefit in diabetes care since it improve glycemic control (10). Peer support define as people who has knowledge in term of specific behavior and or stressor and similar characteristic as target population (11). Previous studies reported peer support intervention effective for maintain medication adherence in people with HIV (12) and improve breast cancer patients' quality of life, emotion (13). Therefore, it has been hypothesized that peer support could be promising intervention for patients with type 2 diabetes mellitus. Consequently, we conducted a integrative review of RCTs to determine the effect of peer support intervention on glycemic control among patients with type 2 diabetes mellitus.  Figure 1).     (18), one in Austria (19), and one in Africa (20). The total respondents of the studies ranged from 104 to 337 patients. The duration of the intervention ranged from three to twenty four months. The mean of the HbA1c at baseline in peer group intervention participants ranging from 7.02 % -10.6%. All of the peer support intervention conducted in group of patients with type 2 diabetes mellitus.

Recruitment and Training of Peer Support
The criteria of the peer support were patients with type 2 diabetes mellitus who had patients allocated to control group a 3-month diabetes self-management education (DSME) program followed by a 12-month peer support intervention with a 3-month DSME program alone Control group = 8.0 Peer-led group= 7.8 an initial DSME program, whether or not followed by 12 months of peer support, had   (18), general practitioner, psychologist, nutritionist, sport scientist (19), and community health worker (14). The key element need to be considering are rigorous process of recruiting, selecting, and training the peer support.

Intervention Modes
There were 2 modes of intervention such as face to face course session and face to face course session with additional telephone support call. The additional telephone contact performed to made regular contact with respondents who had not attended 3 consecutive educational session (14). The involvement of the respondents and the peer support plays significant role in achieving the goal of each study. The high frequency of peer support contact with the respondents significantly improve glycemic control (10). It means the intensive intervention should be implemented.

Effect of intervention on glycemic control
Glycemic control is a factor that determine diabetes complication since the risk of complication correlated with glucose control level (21,22). Study reported patients with controlled HbA1c level lower in risk of microvascular, macro vascular complication and even the death (23,24). The impact of peer support on glycemic control among intervention group presented in table 1. Two studies reported no significant effect of peer support in HbA1c reduction (15,19). The intervention conducted in those studies run 15 months and 24 months. It highlighted that the intervention should be performed in short term period to gain better outcome particularly HbA1c reduction.

CONCLUSION AND RECOMMENDATION
Our study concluded peer support intervention provide potential benefit on glycemic control. The short term duration of the intervention should be considered once this intervention will be implemented. Considering most of the study included implemented in USA, the efficacy of peer support need to be explored in different area.