Puentes hacia una mejor vida (Bridges to a Better Life): Outcome of a Diabetes Control Peer Support Intervention

Ann Fam Med. 2015 Aug;13 Suppl 1(Suppl 1):S9-17. doi: 10.1370/afm.1807.


Purpose: Peer support can promote diabetes control, yet research on feasible and effective peer support models is lacking. This randomized controlled trial tested a volunteer-based model of peer support for diabetes control.

Methods: Thirty-four volunteer peer leaders were recruited and trained to provide support to 5 to 8 patients each through telephone contact, in-person, individual, and group support. Planned dose was 8 contacts, preferably in the first 6 months. Patients with uncontrolled diabetes were randomly sampled from the medical records of 3 community clinics. After a baseline interview and medical records review to obtain baseline values for the primary outcome, HbA1c, 336 patient participants were randomly assigned to a 12-month peer support intervention or usual care. The assessment protocol was repeated at 6 and 12 months after baseline.

Results: Thirty peer leaders delivered an average of 4 contacts each per assigned participant (range 1-24). Despite the lack of intervention fidelity, the intervention was effective at reducing glycated hemoglobin (HbA1c) among intervention as compared with usual care participants (P=0.05). Similar trends were observed in frequency of meeting fruit and vegetable guidelines (P =0.09), a secondary outcome. Counterintuitively, usual care participants reported checking their feet more days out of 7 than intervention participants (P =0.03).

Conclusions: Given the modest changes we observed, combined with other evidence for peer support to promote diabetes control, additional research is needed on how to modify the system of care to increase the level of peer support delivered by volunteers.

Keywords: Hispanic Americans; diabetes control; peer support.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Counseling / methods*
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / psychology*
  • Diabetes Mellitus / therapy
  • Diet, Diabetic / psychology
  • Disease Management*
  • Female
  • Glycated Hemoglobin A / analysis
  • Humans
  • Male
  • Mexican Americans
  • Middle Aged
  • Patient Compliance / psychology
  • Patient Compliance / statistics & numerical data
  • Self Care / methods*
  • Self Care / psychology
  • Social Support*
  • Telephone
  • Treatment Outcome
  • United States
  • Volunteers


  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human