Primary healthcare: People with diabetes will receive some of their healthcare from fellow patients as part of a unique primary care project due to begin in April. A major aim of the scheme is to try to reduce the level of heart attack and stroke in people with diabetes.
Researchers from the Department of Public Health and Primary Care at Trinity College Dublin (TCD) have been awarded an €800,000 grant by the Health Research Board (HRB) to evaluate a model of peer support among certain diabetics.
There are two types of diabetes: type 1 occurs in mainly younger people and is treated with insulin replacement from the onset of the illness; type 2 was, until recently, a disease of older people treated with diet and oral hypoglycaemic drugs, but is now becoming increasingly prevalent in younger men and women who are overweight.
The principal investigator, Dr Susan Smith, who is lecturer in general practice at TCD, said the research funding had been granted under the HRB's R&D scheme. The money will help fund the care of patients with type 2 diabetes in 25 general practices in the greater Dublin area.
Over 400 people will be enrolled in the study. All will receive a high standard of diabetes care according to a written protocol while one half of the participants will be randomly assigned to receive additional care and support from specially selected and trained peers or "buddies", who themselves have type 2 diabetes. They will offer explanation and advice given in layman's language.
These lay healthcare workers must have had diabetes for at least a year; they must also have participated in preventive treatment programmes. Each lay carer will look after seven to eight patients in close liaison with a practice nurse.
At the end of the five-year programme, the researchers will compare specific outcomes in the two groups of patients. They will measure blood pressure, cholesterol, haemoglobin A1c levels (a measure of diabetes control) and the body mass index (BMI) of all participants. Both groups will also be assessed for psychological and social markers of disease. Statistics such as the number of GP and practice nurse visits as well as hospital admissions during the study period will also be recorded.
An economic analysis, to be carried out by Dr Eamon O'Shea, statutory lecturer in economics at the National University of Ireland Galway, will compare the costs and benefits of adding peer support to standardised diabetes care. The researchers, who also include Prof Tom O'Dowd, professor of public health and primary care at TCD, and Dr David Whitford, senior lecturer in general practice at the Royal College of Surgeons in Ireland, will also analyse qualitative issues such as the attitude of patients and healthcare professionals to the addition of lay advisers in diabetes management. "We will use patients' expertise for the benefit of other patients and we hope to improve both physical and psychological outcomes for people with diabetes," Dr Smith said.