Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2012 Mar 20;156(6):416-24.
doi: 10.7326/0003-4819-156-6-201203200-00004.

Peer mentoring and financial incentives to improve glucose control in African American veterans: a randomized trial

Judith A Long  1 , Erica C Jahnle, Diane M Richardson, George Loewenstein, Kevin G Volpp
Affiliations
Randomized Controlled Trial

Peer mentoring and financial incentives to improve glucose control in African American veterans: a randomized trial

Judith A Long et al. Ann Intern Med. .

Abstract

Background: Compared with white persons, African Americans have a greater incidence of diabetes, decreased control, and higher rates of microvascular complications. A peer mentorship model could be a scalable approach to improving control in this population and reducing disparities in diabetic outcomes.

Objective: To determine whether peer mentors or financial incentives are superior to usual care in helping African American veterans decrease their hemoglobin A(1c) (HbA(1c)) levels.

Design: A 6-month randomized, controlled trial. (ClinicalTrials.gov registration number: NCT01125956)

Setting: Philadelphia Veterans Affairs Medical Center.

Patients: African American veterans aged 50 to 70 years with persistently poor diabetes control.

Intervention: 118 patients were randomly assigned to 1 of 3 groups: usual care, a peer mentoring group, and a financial incentives group. Usual care patients were notified of their starting HbA(1c) level and recommended goals for HbA(1c). Those in the peer mentoring group were assigned a mentor who formerly had poor glycemic control but now had good control (HbA(1c) level ≤7.5%). The mentor was asked to talk with the patient at least once per week. Peer mentors were matched by race, sex, and age. Patients in the financial incentive group could earn $100 by decreasing their HbA(1c) level by 1% and $200 by decreasing it by 2% or to an HbA(1c) level of 6.5%.

Measurements: Change in HbA(1c) level at 6 months.

Results: Mentors and mentees talked the most in the first month (mean calls, 4; range, 0 to 30), but calls decreased to a mean of 2 calls (range, 0 to 10) by the sixth month. Levels of HbA(1c) decreased from 9.9% to 9.8% in the control group, from 9.8% to 8.7% in the peer mentor group, and from 9.5% to 9.1% in the financial incentive group. Mean change in HbA(1c) level from baseline to 6 months relative to control was -1.07% (95% CI, -1.84% to -0.31%) in the peer mentor group and -0.45% (CI, -1.23% to 0.32%) in the financial incentive group.

Limitation: The study included only veterans and lasted only 6 months.

Conclusion: Peer mentorship improved glucose control in a cohort of African American veterans with diabetes.

Primary funding source: National Institute on Aging Roybal Center.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Study Flow Diagram
Figure 2
Figure 2. Change in HbA1c for Each Participant by Arm
See this image and copyright information in PMC

Summary for patients in

References

    1. Gallant MP. The influence of social support on chronic illness self-management: a review and directions for research. Health Educ Behav. 2003 Apr;30(2):170–195. - PubMed
    1. Lloyd CE, Wing RR, Orchard TJ, Becker DJ. Psychosocial correlates of glycemic control: the Pittsburgh Epidemiology of Diabetes Complications (EDC) Study. Diabetes Res Clin Pract. 1993 Aug-Sep;21(2-3):187–195. - PubMed
    1. Glasgow RE, Toobert DJ. Social environment and regimen adherence among type II diabetic patients. Diabetes Care. 1988 May;11(5):377–386. - PubMed
    1. Ruggiero L, Spirito A, Bond A, Coustan D, McGarvey S. Impact of social support and stress on compliance in women with gestational diabetes. Diabetes Care. 1990 Apr;13(4):441–443. - PubMed
    1. Tillotson LM, Smith MS. Locus of control, social support, and adherence to the diabetes regimen. Diabetes Educ. 1996 Mar-Apr;22(2):133–139. - PubMed

Publication types

Associated data