Peer advisers compared with specialist health professionals in delivering a training programme on self-management to people with diabetes: a randomized controlled trial.

AIMS: To assess the effectiveness and acceptability of peer advisers in diabetes in delivering a programme of training on self-management for people with diabetes. METHODS: Adults with diabetes were randomly allocated to an education programme delivered either by trained peer advisers or by specialist health professionals. The primary outcome measure was change in knowledge tested before and at the conclusion of the four courses, each consisting of six sessions. Glycated haemoglobin and Diabetes Care Profile were assessed at baseline and at 6 months. Sessional and end-of-course evaluation responses were analysed, as was the attendance record. RESULTS: Eighty-three patients were randomized. Of these, 14 failed to attend and two were excluded. Knowledge scores improved significantly in both groups, but there was no difference between the groups for any of the knowledge domains. No difference was noted in the Diabetes Care Profiles or in glycated haemoglobin. The attendance record was similar in both groups. In the post-sessional evaluations, both groups scored highly, with the health professionals significantly more so. The post-course questionnaire exploring patients' understanding and confidence in self-management of specific aspects of diabetes care revealed no difference between the groups. CONCLUSIONS: Trained patients are as effective in imparting knowledge to their peers as specialist health professionals. Both are also acceptable to patients as trainers. However, lay tutors require to be given appropriate training, specific to the education programme they would be expected to deliver.

Fatal phenytoin hypersensitivity syndrome.

The phenytoin (hydantoin) hypersensitivity syndrome is rare but potentially fatal. Often, as in this case, it presents with non-specific symptoms and signs, requiring a high degree of clinical suspicion for diagnosis.