From the Philadelphia Veterans Affairs Center for Health Equity Research and Promotion and University of Pennsylvania Leonard David Institute of Health Economics, Center for Health Incentives, Philadelphia, and Carnegie Mellon University, Pittsburgh, Pennsylvania.
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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 A1c (HbA1c) 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 HbA1c level and recommended goals for HbA1c. Those in the peer mentoring group were assigned a mentor who formerly had poor glycemic control but now had good control (HbA1c 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 HbA1c level by 1% and $200 by decreasing it by 2% or to an HbA1c level of 6.5%.Measurements:Change in HbA1c 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 HbA1c 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 HbA1c 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.