The effect of peer support in adults with insulin pump-treated type 1 diabetes: a pilot study of a flexible and participatory intervention

Figures & data

Table 1 Dialogue tools and exercises

Tool/exercise	Illustration	Aim and description
Who am I?		Aim: to give participants the opportunity to introduce themselves to each other by selecting pictures with different associations Description: when participants choose a picture and say precisely why it is relevant, it enables them to talk about other aspects of themselves than they usually do. The exercise also enables participants to discover possible common interests and to laugh together Use: as an introduction at the first meeting
Question sheet		Aim: to address and discuss topics relevant to participants Description: participants individually write down questions regarding specific topics they want to ask other people about Use: as a starting point for discussions during meetings
My social relationships	My social relationships Please complete the six incomplete sentences with the first thing that comes to mind. I get good support from… I get too little support from… People who know how I live feel that I… I think my friends think… It irritates me when other people… I am pleased when other people…	Aim: to help participants gain insights into and clarify their experiences and needs with respect to how those around them react to them as individuals with a chronic condition Description: participants are asked to complete sentences in which the first word relates to their social relationships Use: participants discussed their challenges during meetings
Postcard		Aim: to help participants reflect on what good advice they feel that it would be important to give to others in insulin pump treatment Description: participants take the “postcard” and a brief instruction home. They can reflect on the questions until the next session and can also fill in the postcards Use: participants discussed their questions in group meetings
Photo exercise		Aim: to help participants share concrete experiences from everyday life Description: participants were asked to take photos of challenges and successes with the insulin pump in everyday life with diabetes and bring the photos to the next meeting Use: participants shared and discussed their photos in group meetings
Dialogue tool		Aim: to enhance and ease dialogue between participants Description: the cards are used as “openers” in dialogues on optional topics between peers The first thing that comes to my mind is… I would like to focus on… I like it most when… I think it is difficult when… Use: participants used the tool during group meetings

Note: Copyright © 2011 Steno Diabetes Center Copenhagen. Images used in the table reproduced from Engelund G, Vinther-Andersen N, Hansen UM, Willaing I. In balance with chronic illness. Tools for patient education. Gentofte, Denmark: Steno Diabetes Center Copenhagen.³⁸

Table 2 Characteristics of participants

	All participants (N=30)	Participants completing both questionnaires (N=27)
Female, n (%)	21 (70.0)	18 (66.7)
Age in years, mean (range)	50.5 (31–71)	51.3 (31–71)
Education, n (%)
Primary school	2 (6.7)	2 (7.4)
Upper secondary or vocational school	7 (23.3)	6 (22.2)
Short higher education	3 (10.0)	2 (7.4)
Medium higher education	11 (36.7)	11 (40.7)
Long higher education	6 (20.0)	5 (18.5)
Other educations	1 (3.3)	1 (3.7)
Household composition, n (%)
Living alone	5 (16.7)	5 (18.8)
Living with a partner or spouse	22 (73.3)	19 (70.4)
Living with children or adolescents <20 years old	9 (30.0)	7 (25.9)
Living with other adults	3 (10.0)	3 (11.1)
Perceived as very or somewhat supportive in diabetes care, n (%)
Family and friends	30 (100)	27 (100)
Colleagues	17 (56.7)	16 (59.3)
Health care professionals	27 (90)	24 (88.9)
Local community	11 (36.7)	10 (37.0)
Baseline high of very high diabetes-related social support, n (%)
Could contact people interested in my diabetes management	21 (70.0)	19 (70.4)
Could contact people with diabetes to share experiences about diabetes management	16 (53.3)	15 (55.6)
HbA1c (mmol/mol), mean (range)a	58.9 (47–72)	58.6 (47–69)

Note:

a Excludes HbA1c levels for one participant who was pregnant when she participated in the meetings and gave birth shortly afterward.

Abbreviation: HbA1c, hemoglobinA1c.

Table 3 Themes and example quotes of perceived outcomes

Themes	Quotes
Diabetes-specific social capital	To have confirmed that others are dealing with some of the same things you are … and then, in that particular space feel that you are not alone. That to a great extent you are having the same thoughts. That’s nice in some way. I don’t know why […] [male] I have learned a lot about how similar we all feel. You know, and that has been the main issue for me, to find out that it is the same things we struggle with all the time. So those are the conditions when you have diabetes. Uhm, those are the things we struggle with, meaning that I am not special [female]
Motivation and changes in everyday life	It was an epiphany. Wow, it can really vary that much, just because of the injection site. Okay. I have that with me now where I rotate and think … You know, if I had only known the thing about that place under the navel or something that didn’t work. Now I have other zones. [female] I was discussing exercising with [another participant]. He was a great inspiration to me. You know, I promised him at the third meeting, that the next time we met, I would have started running again. I had started running at that time and I have actually started running regularly since. It really motivated me. [female]
Awareness of own diabetes practice and differences among people with type 1 diabetes	That is also something I think you can take with you from talks like that. That once in a while you think about it and … well. I always do this in a certain situation, or what it is you do, right. It doesn’t have to be like that! [male] Yes, well … it is slightly embarrassing, but every time as I was leaving I thought – sort of smugly – because there were some things that surprised me. For example, people who had not told their workplace about their diabetes. I think that is completely senseless. I actually felt kind of complacent and smug about how I was open about having diabetes. For me, that confirmed that I was right in doing that – yes. [male] It is a very individual disease in that way … You have to pay attention to yourself and believe in yourself. [female]
Serenity and openness in life with diabetes	I feel more at ease now because I thought it was only me who had these problems. Now it turns out there were a bunch of others and with that in mind I can kind of say, ok it’s not stupid. It gives me a certain ease of mind. [male] I also believe that I have become even more open about my disease when relating to others … I think it is because – you know, in the course of these four meetings, I have both heard so much and shared quite a few things myself about my diabetes, and that has felt really quite natural. Not to say that it perhaps didn’t before, but it is just to a much larger degree now. I really think so. I think that is part of what I learned. Definitely. [female]
Feeling sad or upset	I would have wished that it worked for me and that I could just sit and share my experiences and just be together regularly. It actually makes me kind of upset, even more upset than I usually am, when I come and hear how everyone else feels really well. I don’t know if they do, that is not how I would put it. They do not all feel great, but they are happy with the pump, most of them. I think so. [female] Then I was at my parents […] and there was some discussion or I talked about how I was low [in blood glucose] or something – and then I didn’t feel like I was being met, and then I thought – then I drew on the reflections I had from the [peer support] meetings. Then I thought: they just don’t understand me. It was reinforced in a way – that there was no real understanding. I don’t think I’ve ever felt that ill. [female] There were a few people [at the peer support meetings] who worked part time and that makes me kind of sad, when you are not able to have a full-time job with diabetes. To me, it sounded like that was almost impossible for some people and I know some of them have other illnesses than diabetes, but that made me a bit sad. [female]
Awareness of treatment and support possibilities	Before, I had the sense that it was – I don’t know if you can say, I think very troublesome. You know, the pump is a whole new form of treatment and that was also very troublesome, so I sort of felt like – I can’t do it. But after the meetings I feel like – there were people there who had had a sensor, but thrown it away because it wasn’t for them at all. But on the other hand, there were also people who said that could not imagine life without it and that it had really helped them in a lot of ways. It gave them a sense of comfort – that they were better able to relax in some way. So that made me really, really curious. Afterward, when I was at control at Hvidovre [Hospital] I spoke to my doctor and she said that she thought trying it out was a good idea, too. [female] After the meetings, I have begun using that app [from the Danish Diabetes Association]. That is a very concrete example of something I have done afterward. [female]

Table 4 Baseline and postintervention HbA1c, well-being, diabetes empowerment, diabetes distress, loneliness, and social support

	Baseline (N=27)	Postintervention (N=27)	P-valuesa
HbA1c (mmol/mol), mean (range)b	58.6 (47–69)	58.0 (47–67)	0.41
WHO-5 score, mean	62.2	63.6	0.67
DES-SF score <4, n (%)	18 (66.7)	18 (66.7)	0.49
T1-DDS score ≥3, n (%)
Overall distress	2 (7.4)	1 (3.7)	0.27
Powerlessness	6 (22.2)	6 (22.2)	0.08
Negative social perceptions	2 (7.4)	2 (7.4)	NAc
Physician distress	1 (3.7)	1 (3.7)	NAc
Friend/family distress	1 (3.7)	0 (0)	0.73
Hypoglycemia distress	4 (14.8)	4 (14.8)	0.89
Management distress	3 (11.1)	3 (11.1)	0.18
Eating distress	10 (37.0)	7 (25.0)	<0.001
Loneliness and social support, n (%)
Other people with type 1 diabetes are very/somewhat supportive in diabetes care	15 (55.6)	20 (74.1)	<0.001
Rarely feel isolated from others	19 (70.4)	20 (74.1)	0.003
Rarely feel starved for company	20 (74.1)	20 (74.1)	0.12
Rarely feel left out	24 (88.9)	24 (88.9)	0.15
Rarely miss someone to talk to about diabetes	8 (29.6)	14 (51.9)a	<0.001
Rarely feel lonely with diabetes	10 (37.0)	12 (46.2)	0.10

Notes:

a P-values from the Wilcoxon signed-rank test (binary outcomes) and paired t-tests (linear outcomes).

b Excludes HbA1c levels for one participant who was pregnant when she participated in the meetings and gave birth shortly afterward.

c No discordant pairs.

Abbreviations: DES-SF, Diabetes Empowerment Scale-Short Form; HbA1c, hemoglobin A1C; T1-DDS, Type 1 Diabetes Distress Scale; WHO-5, 5-item World Health Organization Well-Being Index.

EngelundGVinther-AndersenHansenUMWillaingIIn balance with chronic illness. Tools for patient educationGentofte, DenmarkSteno Diabetes Center Copenhagen2011

 Google Scholar