Peer Support Reduces Hospitalizations in People With Diabetes and Depression
The study population included adults with T2D from 8 counties in southern rural Alabama, where there is a disproportionately high prevalence of diabetes.
For patients with diabetes and comorbid depression, the addition of peer support for managing diabetes resulted in a significant reduction in acute care and hospital utilization compared with patients without depression, according to study results published in Diabetes Care.
The investigators of this 1-year, cluster-randomized, controlled study sought to examine the impact of peer support on the rate of acute care visits and hospitalizations in high-risk individuals with type 2 diabetes (T2D) with or without depressive symptoms.
The study population included 360 adults with T2D from 8 counties in southern rural Alabama who were randomly assigned by community-based practices to receive 1 year of peer support (n = 168) or usual care (n = 187). Outcome measures were collected at baseline, 6 months, and 12 months. Investigators evaluated depressive symptoms using the Patient Health Questionnaire (PHQ-8) and categorized symptoms as mild (PHQ-8 score 5-9), moderate to severe (PHQ-8 score ≥10), or none (PHQ-8 score <5).
Acute care and hospital utilization was assessed per year by self-report. Regression analysis was performed to examine associations between acute care visits/hospitalizations and receiving peer support intervention and how these differed among participants with and without depressive symptoms.
At baseline, half of the total study population reported mild depressive symptoms (P =.37), and a quarter of the population reported moderate depressive symptoms (P =1.0). There were also no significant differences in the acute care and hospital utilization rates between the intervention and control groups at baseline; however, individuals with depressive symptoms reported more acute care visits.
At follow-up, patients with mild depressive symptoms who received peer support reported 74% fewer hospitalizations than control participants (incident rate ratio [IRR], 0.26 per 10 person-years; 95% CI, 0.08-0.84) and fewer acute care visits (IRR, 0.55 per 10 person-years; 95% CI, 0.28-1.07). The investigators encountered similar results when comparing intervention and control participants with moderate to severe depressive symptoms. No difference between acute care and hospital utilization was observed between the intervention and control participants without depressive symptoms.
Limitations to the study included self-reported measures of primary outcomes by the study participants. In addition, because the study sample largely consisted of African Americans living in the rural South, results may not be generalizable to other populations.
Patients with diabetes and depressive symptoms who received community-based peer support for diabetes management reported less frequent acute care visits and hospitalizations than patients with diabetes without depressive symptoms. Identification of comorbid depression and the addition of appropriate health management can improve outcomes and help mitigate costs related to acute care and hospital utilization in this high-risk population.
Cherrington AL, Khodneva Y, Richman JS, Andreae SJ, Gamboa C, Safford MM. Impact of peer support on acute care visits and hospitalizations for individuals with diabetes and depressive symptoms: a cluster-randomized controlled trial [published online October 29, 2018]. Diabetes Care. doi:10.2337/dc18-0550