General Medicine Services, VA Puget Sound Health Care System, Seattle, Washington, United States of America.
Department of Medicine, University of Washington, Seattle, Washington, United States of America.
PLoS One. 2020 Jun 25;15(6):e0235037. doi: 10.1371/journal.pone.0235037. eCollection 2020.
Substantial evidence supports the effectiveness of peer educator programs for diabetes management in low- and middle-income countries. However, little is known about peer educators' impact relative to other treatment components such as medication and physician consultation. In Cambodia, the non-governmental organization MoPoTsyo organizes four services for people with diabetes: self-management training through peer educator visits, lab tests, physician consultations, and low-cost medicines. Our aims were to 1) quantify MoPoTsyo participant utilization of each program service and 2) define the relationship between each program service and glycemic control.
We conducted a retrospective cohort study among 4,210 MoPoTsyo participants, using data collected by MoPoTsyo from 2006-2016. Independent variables assessed were medication adherence, number of peer educator visits, number of physician consultations, and number of lab tests. A multiple logistic regression model was used to evaluate the association between these disease management services and glycemic control-fasting plasma glucose ≤130 mg/dl or post-prandial glucose ≤180 mg/dl-based on most recent glucose level. The model was adjusted for baseline demographic and disease characteristics.
Participants with 12 or more peer educator visits per year had a 35% higher odds of glycemic control relative to participants with 4 or fewer visits (odds ratio 1.35, 95% CI: 1.08-1.69; p = 0.009), after adjustment for utilization of other treatment components (medication adherence, number of physician visits, number of lab tests), follow-up time, and demographic and disease characteristics. Better adherence to medications and a greater number of lab tests per year were also associated with a higher odds of glycemic control after adjustment. Number of physician consultations was not associated with glycemic control after adjustment.
This study demonstrates a positive association between peer educator utilization and glycemic control incremental to other elements of diabetes management. These results suggest that peer educators may be a valuable addition to comprehensive diabetes management programs in low- and middle-income countries even when other health care services are accessible. The associations identified in this research warrant further prospective studies to explore the causal impact of peer educators on glycemic control relative to other disease management components.
大量证据表明，同伴教育者计划在中低收入国家对糖尿病管理非常有效。然而，对于同伴教育者相对于其他治疗组成部分（如药物和医生咨询）的影响知之甚少。在柬埔寨，非政府组织 MoPoTsyo 为糖尿病患者组织了四项服务：通过同伴教育者访问、实验室测试、医生咨询和低价药品进行自我管理培训。我们的目的是：1）量化 MoPoTsyo 参与者对每个项目服务的利用情况，2）定义每个项目服务与血糖控制之间的关系。
我们对 4210 名 MoPoTsyo 参与者进行了回顾性队列研究，使用 MoPoTsyo 从 2006 年至 2016 年收集的数据。评估的自变量包括药物依从性、同伴教育者访问次数、医生咨询次数和实验室测试次数。基于最近的血糖水平，使用多因素逻辑回归模型评估这些疾病管理服务与血糖控制（空腹血糖≤130mg/dl 或餐后血糖≤180mg/dl）之间的关系。该模型调整了基线人口统计学和疾病特征。
每年接受 12 次或更多同伴教育者访问的参与者，血糖控制的可能性比每年接受 4 次或更少访问的参与者高 35%（优势比 1.35，95%CI：1.08-1.69；p=0.009），调整其他治疗组成部分（药物依从性、医生就诊次数、实验室检查次数）、随访时间以及人口统计学和疾病特征后。更好的药物依从性和每年更多的实验室检查次数也与调整后血糖控制的可能性更高相关。调整后，医生咨询次数与血糖控制无关。
本研究表明，同伴教育者的利用与血糖控制之间存在积极的关联，这是对糖尿病管理其他要素的补充。这些结果表明，即使在可获得其他医疗保健服务的情况下，同伴教育者也可能是中低收入国家综合糖尿病管理计划的有价值的补充。本研究中确定的关联需要进一步的前瞻性研究，以探索同伴教育者相对于其他疾病管理组成部分对血糖控制的因果影响。
