Diabetes peer coaching: do "better patients" make better coaches?

Purpose: The purpose of this study was to identify characteristics of peer coaches associated with improvement in diabetes control among low-income patients with type 2 diabetes.

Methods: Low-income patients with type 2 diabetes who spoke English or Spanish from 6 urban clinics in San Francisco, California, were invited to participate in the study. Twenty participants received training and provided peer coaching to 109 patients over a 6-month peer coaching intervention. Primary outcome was average change in patient glycosylated hemoglobin (A1C). Characteristics of peer coaches included age, gender, years with diabetes, A1C, body mass index (BMI), levels of diabetes-related distress, self-efficacy in diabetes self-management, and depression.

Results: Patient improvement in A1C was associated with having a coach with a lower sense of self-efficacy in diabetes management (P < .001), higher level of diabetes-related distress (P = .01), and lower depression score (P = .03).

Conclusions: Coach characteristics are associated with patient success in improving A1C. "Better" levels of coach diabetes self-efficacy and distress were not helpful and, in fact, were associated with less improvement in patient A1C, suggesting that some coach uncertainty about his or her own diabetes might foster improved patient self-management. These coach characteristics should be considered when recruiting peer coaches.