Study findings support reciprocal peer support as a method of improving diabetes management.

Many patients with diabetes would benefit from assistance in self-managing their condition between clinic visits, say Michele Heisler (University of Michigan Medical School, Ann Arbor, Michigan, USA) and colleagues.

Nurse-led assistance has been shown to be effective, but providing this sort of care can be difficult in a real-life setting, especially when resources are low.

In this study, Heisler and team assessed the efficacy of reciprocal peer support (RPS), where patients are paired with another age-matched patient and given peer communication skills training, versus nurse care management (NCM) for improvement of diabetes self-management.

The researchers recruited 244 men with diabetes and glycated hemoglobin (HbA1c) levels during the preceding 6 months greater than 7.5%.

The primary outcome was 6-month change in HbA1c. In total, 113 and 103 men were randomly assigned to and completed the 6-month RPS or NCM interventions, respectively.

Mean HbA1c decreased by 0.29% in the RPS group, but increased by 0.29% in the NCM group, amounting to a significant 0.58% between-group difference.

When the researchers looked at men with an initial HbA1c greater than 8%, those in the RPS group had a reduction in HbA1c of 0.88% versus 0.07% for those in the NCM group.

The RPS patients were encouraged to talk to their paired partner at least once a week on the telephone and were given the option to attend occasional group sessions at 1, 3, and 6 months. Those in the NCM group attended an initial 1.5-hour diabetes education session and were then assigned to a Nurse Care Manager and encouraged to contact them if they needed help with their diabetes management.

Writing in the Annals of Internal Medicine, the authors write that “periodic nurse-facilitated, patient driven group sessions supplemented with one-on-one peer-support telephone calls between age-matched partners improved glycemic control and other key outcomes more than providing NCM services alone among diabetic men.”

They say: “Because many chronically ill patients need more support for self-care than most health care systems can provide, models that increase the quality and intensity of assistance through peer support, such as ours, deserve further exploration.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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Researchers report that treatment with metformin appears to reduce mortality rates in patients with heart failure (HF) and diabetes.

David Aguilar (Baylor College of Medicine, Houston, Texas, USA) and colleagues explain that although diabetes and HF commonly co-exist, optimal treatment for such patients has not been studied in detail.

To investigate the possible benefits of metformin for these patients, Aguilar and team studied mortality rates over 2 years of follow-up in 6185 patients with HF and diabetes, of whom 1561 were treated with metformin and 4624 were not.

All the patients were taking a combination of other drugs including: insulin, sulfonylureas, thiazolidinediones, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, spironolactone, beta blockers, and statins.

As reported in the journal Circulation: Heart Failure, 246 (15.8%) patients taking metformin and 1177 (25.5%) of those who were not taking the medication died during follow-up, a statistically significant between-group difference.

The researchers carried out a propensity-score (probability of being treated given the covariates) matched analysis. This showed that death occurred within 2 years in 232 (16.1%) and 285 (19.8%) patients in the metformin and no metformin groups, respectively, corresponding to a significant 24% reduction in the relative risk for death with metformin.

Of note, the investigators found no significant differences in hospitalization for HF or total hospitalization rates between the two groups.

“Given the current burden and expected growth in the number of patients with diabetes and HF, it is critically important that future studies assess the optimal treatment strategy for glycemic control in this population,” say Aguilar and co-authors.

“Addressing these issues will require carefully designed prospective observational studies to confirm safety and randomized controlled clinical trials to assess efficacy,” they conclude.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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Elderly Type 2 diabetes patients have limited joint mobility (LJM) compared with their nondiabetic peers, show study findings.

LJM has previously been observed in young Type 1, but not older Type 2, diabetic patients, explain Michele Abate (University G d’Annunzio Chieti-Pescara, Chieti Scalo, Italy) and colleagues.

In the current study, the team investigated the frequency of LJM in 30 elderly, well-controlled Type 2 diabetics, aged 73.9 years on average. For comparison purposes, 30 age- and gender-matched nondiabetics were also included, as were 10 young nondiabetics aged 26.3 years on average.

The team evaluated the range of motion (ROM) of the ankle, knee, elbow, shoulder, and hip joints using a double-armed goniometer. They also measured abnormalities of the supraspinatus, patellar, and Achilles tendons using a standardized ultrasound technique.

As might be expected, elderly individuals (diabetic and nondiabetic) had a significantly lower mobility in all joints except the knee and elbow flexion compared with the younger controls.

In addition, elderly diabetic patients had a significantly greater degree of LJM than their nondiabetic counterparts, particularly for ankle dorso- and plantar flexion (ROM=8.0 and 25.0° vs 11.9 and 32.9°, respectively), hip flexion and adduction (ROM=103.1 and 29.0° vs 116.0 and 32.1°, respectively) and shoulder abduction and flexion (ROM=138.0 and 137.0° vs 158.0 and 149.0°, respectively).

Abate and co-workers also observed a greater number of tendon abnormalities on ultrasound in diabetic than nondiabetic elderly participants.

The authors write that non-enzymatic glycosylation of collagen with advance glycation endpoints (AGEs) formation, and the subsequent increase of intermolecular collagen cross-links, is likely to be the main pathogenetic mechanism for LJM in diabetes patients.

Writing in the Archives of Gerontology and Geriatrics, the authors conclude: “Beside physiotherapy and proper control of hyperglycemia, pharmacological interventions, which may influence AGE formation or removal, and prevent or reverse joint stiffness, are desirable.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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