Source/Disclosures
Disclosures: Warshaw reports no relevant financial disclosures. Weiner reports she is a clinical adviser to Livongo Health.
July 20, 2020
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Diabetes peer support matters — Here’s how to find it

Source/Disclosures
Disclosures: Warshaw reports no relevant financial disclosures. Weiner reports she is a clinical adviser to Livongo Health.
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Susan Weiner 2019
Susan Weiner

In this issue, Susan Weiner, MS, RDN, CDN, CDCES, FADCES, talks with registered dietitian and diabetes care and education specialist Hope Warshaw, MMSc, RD, CDE, BC-ADM, FADCES, about diabetes peer support.

This relatively new form of mental health support can improve emotional wellbeing and, potentially, clinical outcomes for people with diabetes. Clinicians should embrace opportunities to link people with diabetes and their caregivers with peer support communities.

Susan Weiner, MS, RDN, CDN, CDCES, FADCES, talks with registered dietitian and diabetes care and education specialist Hope Warshaw, MMSc, RD, CDE, BC-ADM, FADCES, about diabetes peer support.

What is peer support as it relates to diabetes and how did you become involved with it?

Warshaw: I’ll offer two related definitions. The first focuses on using a person’s own knowledge and experiences to support someone with diabetes or a family member or caregiver of someone with diabetes. It provides the caveat that peer support complements and enhances, but does not replace, other health care services. The second focuses on health-enhancing changes that result from interactions, education and support from peers with the same condition.

Going back roughly a decade, as social media and networking was becoming popular, I began observing a burgeoning community of people with diabetes who were engaging and supporting each other in new ways. A variety of online communities formed and grew. They overflowed to in-person gatherings and interactions. I have seen, heard and have had the opportunity to share how “finding one’s tribe” has been life-changing for people with diabetes and their caregivers. I’ve been able to meet and work closely with some of these individuals to promote the value of peer support within and on behalf of the Association of Diabetes Care and Education Specialists (ADCES).

Can peer support improve clinical outcomes and self-care behaviors in diabetes care?

Warshaw: There is beginning to be some research on this question. A scoping review and gap analysis of diabetes online communities published in Journal of Diabetes Science and Technology, strongly suggested that use of online diabetes peer-support communities was highly beneficial with few downsides. This was identified as an emerging area of research with existing gaps in our current knowledge. A systematic review of reviews on the value of peer support for people with diabetes, published in The Diabetes Educator, examined both in-person and technology-mediated modalities. The researchers found that a variety of peer support interventions can positively influence clinical outcomes such as HbA1c, blood pressure, cholesterol and weight; behavioral outcomes such as diabetes knowledge, being active, healthy eating, medication management, self-management, self-efficacy and empowerment; and psychosocial outcomes such as social support, health and diabetes distress, depression and quality of life.

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Lastly, I’ll point to the recently published “Perspectives in Practice” on the role and value of peer support in diabetes care and education, published in The Diabetes Educator, that I authored with several colleagues. This document reviews the body of evidence and encourages clinicians who deliver diabetes care to become aware of and refer people with diabetes and caregivers to options and opportunities for peer support. At this time, although peer support has been shown to be of value to people with diabetes and caregivers, it continues to be woefully underutilized, particularly by millions of people with type 2 diabetes. It is my hope that with greater knowledge clinicians will help to change this paradigm.

How and where are people with diabetes and their caregivers engaging in peer support?

Warshaw: Beyond our observations, the best insight we have to answer this question is from the “netnographic” analysis of what mainly younger people with type 1 diabetes are doing online. Tenderich and colleagues essentially pulled back the curtain to explore the value of engaging online for these individuals. The researchers evaluated roughly 500 social media content pieces from various online platforms and found humor, diabetes pride, community building, personal relationship with their diabetes technology, tips and tricks to manage diabetes, and venting about having and having to manage diabetes. This study had three important messages for clinicians about how they can be more authentic with people with diabetes: Be real by demonstrating your compassion about the challenges of managing diabetes; share the realities of having diabetes, don’t “sugarcoat” it; and value the importance of belonging to a “tribe” as a means to feel less isolated.

The third point is exactly why clinicians should be aware of online and off-line ways that people with diabetes and caregivers can connect to participate in and benefit from peer support. These connections can make a world of difference in a person’s attitude and wellbeing, which can translate to improved clinical outcomes.

How can diabetes clinicians introduce the concept of peer support and integrate it seamlessly into the care they provide?

Warshaw: As clinicians we must realize that people with diabetes spend extremely little time interfacing with us. They spend the vast majority of time managing this challenging and increasingly complex disease on their own or with the guidance of caregivers and other loved ones. We all know managing diabetes 24/7 can affect the emotional wellbeing of the person with diabetes and caregivers. Peer support can help. For starters, assess a person’s level of social support by asking an open-ended question, such as “Do you know or interact with other people with diabetes?” I encourage clinicians to explore the tools and resources developed by ADCES for both clinicians (available online at DiabetesEducator.org/PeerSupportforHCP) and for people with diabetes and caregivers (available online at DiabetesEducator.org/PeerSupport).

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References:

For more information:

Hope Warshaw, MMSc, RD, CDE, BC-ADM, owns Hope Warshaw Associates, LLC, a nutrition and diabetes-focused consultancy based in Asheville, North Carolina. She has been an advocate for promoting the value of peer support to health care providers and people with diabetes for more than a decade. She can be reached at hope@hopewarshaw.com. Twitter: @hopewarshaw.

Susan Weiner, MS, RDN, CDN, CDCES, FADCES, is co-author of The Complete Diabetes Organizer and Diabetes: 365 Tips for Living Well. She is the owner of Susan Weiner Nutrition PLLC and is the Endocrine Today Diabetes in Real Life column editor. She can be reached at susan@susanweinernutrition.com; Twitter: @susangweiner.