Description of Intervention
3-Month Diabetes Self-Management Education
Program
Both intervention and control groups received a
3-month DSME program delivered by a certified diabetes
educator and 2 peer leaders (PLs). A detailed
description of PL recruitment, selection and training and
the diabetes educator’s background are reported elsewhere.14
The 3-month program consisted of 12 weekly
90-minute group sessions. The diabetes educator was
responsible for delivering diabetes education while the 2
PLs directed behavior change activities. In the first session,
each participant received a personalized diabetes
complications risk profile that included clinical results
from the baseline assessment and strategies to improve
each measure. Results were also mailed to participants’
self-identified providers. Participants were paired with
PLs for one-on-one support activities outside of group
sessions. During the 3-month program, PL-participant
teams were expected to schedule 2 face-to-face meetings
to explore motivation for making changes, identify
a self-management goal, and develop an action plan. PLs
were expected to make 3 follow-up telephone support
calls per participant to assess participants’ progress.
Ongoing Diabetes Self-Management Support (DSMS)
The 12-month ongoing DSMS component (the
“PLEASED intervention”) was designed to provide
ongoing emotional and behavioral support delivered
by PLs through weekly group sessions and follow-up
telephone contacts. Participants were encouraged to
attend sessions as often as they needed or were able to
given competing life demands. Discussion topics were
guided by patients’ self-management questions and
concerns. While not curriculum-driven, each session
addressed 5 core components:
• Reflecting on recent self-management challenges or
evaluating action plans from the previous week
• Sharing feelings about these challenges and other
aspects of living with diabetes
• Engaging in group-based problem-solving
• Raising questions about diabetes and its care
• Setting self-management goals and developing action
plans
The PLs helped participants set goals using the 5-step
behavioral goal-setting model.15 To ensure regular
contact with each participant, PLs made a telephone
support call to any participant who had not attended a
DSMS session in 3 consecutive weeks. The content of
the telephone calls closely mirrored group-based support
activities.
Participants in both study groups were encouraged
to continue to receive routine care from their
community-based diabetes providers. Given that participants
were coming from many different health care
systems, it was not feasible to assess the routine care
they received using a standardized approach.