Support for Diabetes Self-Management

Supporting people living with diabetes to manage their own illness and improve their health is one of the key features of chronic disease prevention and management.1 Self-management support goes beyond education to providing people with the skills, tools and confidence they need to take control of their illness and make positive changes in their lives.

Randomized controlled trials and “real-life” evaluations have shown that peer support contributes to improved diabetes self-management, including medication adherence, diet, exercise, and blood glucose monitoring.2 The Chronic Disease Self-Management Program, developed by Stanford University, is one example. Largely taught by trained peers, the program focuses on problem-solving, decision-making and confidence-building.3 Randomized controlled trials and “real-world” evaluations of the program have attributed improved health outcomes and reduced visits to emergency rooms.4

In an overview of peer support models for diabetes self-management, Michelle Heisler identified a variety of models of peer support, their effectiveness and the key features that made them effective. Heisler found that many people face barriers to attending structured programs such as the Stanford program. Informal 1:1 support, sometimes called peer mentoring, is also effective, especially with members of population groups who have a distrust of the health care system.5

People with mental illness often experience stigma in the health system.6 Support from others who have similar life experience is often welcomed. Peer mentors are people who have experienced the same challenges as the people they are supporting. Studies have found that peer mentoring improves coping skills and health outcomes for people with cancer, women experiencing postpartum depression and HIV/AIDs patients, as well as improved self-care in heart-failure patients. Training of peer mentors focuses on communication skills, including empathic listening, supporting people to get clear on their values and goals in life, problem solving, and assertiveness.7

A more formal model of unstructured peer support is provided by people who come from the same cultural group but may not have experienced the same illness (e.g., diabetes). This type of peer support often includes helping people to access the resources they need, educating them about the illness and self-care; supporting them to develop the skills to manage the illness; providing social support; and liaising with the health care system. They have been shown to be particularly helpful with vulnerable populations. By developing close, trusting relationships with the people they serve, they improve their quality of life, providing encouragement, education, connection to health and community resources, overcoming barriers such as lack of transportation and unstable work or home situations This type of peer support program has have improved health care access, prenatal care, pregnancy and birth outcomes, health status, and health- and screening-related behaviours among participants in the programs. Telephone and web-based peer support has also been evaluated and found to be promising for people who are not willing or not able to be involved in face to face peer support.8

» See also Mental Health Peer Support


Related Resources

Michelle Heisler, “Building Peer Support Programs to Manage Chronic Disease: Seven Models for Success,” December 2006.

Peers for Progress, Examples of Peer Support Training Curricula.

World Health Organization, “Peer Support Programs in Diabetes,” Report of a WHO Consultation, 5-7 November 2007.


References

[1] See the original chronic disease model developed in the US, the model adapted for BC, and the Ontario framework: Edward H. Wagner, Brian T. Austin and Michael Von Korff, “Organizing Care for Patients with Chronic Illness,” The Milbank Quarterly 74, no. 4 (1996): 511-543; Victoria J. Barr et al., “The Expanded Chronic Care Model: An Integration of Concepts and Strategies from Population Health Promotion and the Chronic Care Model,” Hospital Quarterly 7, no. 1 (2003): 73-82; Ontario Ministry of Health and Long-Term Care, “Preventing and Managing Chronic Disease: Ontario’s Framework” (2007), p. 14.

[2] Michelle Heisler, “Overview of Peer Support Models to Improve Diabetes Self-Management and Clinical Outcomes,” Diabetes Spectrum 20, no. 4 (2007): 214-22.

[3] Stanford University, Diabetes Self-Management Program, patienteducation.stanford.edu.

[4] Kate Lorig et al., “Effect of a Self-Management Program on Patients with Chronic Disease,” Effective Clinical Practice 4, no. 6 (2001): 256-262.

[5] Heisler, 2007.

[6] Canadian Alliance on Mental Illness and Mental Health, “Mental Health Literacy: A Review of the Literature” (2007) and “Mental Health Literacy in Canada: Phase One Draft Report, Mental Health Literacy Project” (2007); Neasa Martin et al., “A Time for Action: Tackling Stigma and Discrimination” (2007).

[7] Heisler, 2007.

[8] Heisler, 2007.