Community-Based Peer Support for Diabetes Management: 24-Month Changes Relative to Comparison Communities

Objective Evaluate effectiveness of community-based peer support for diabetes self-management with HbA1c and other clinical and psychosocial outcomes over 24 months. Research design and methods Intervention comparison design with 12 Intervention communities and 4 Comparison communities matched according to location in urban or suburban areas. Community organization approach integrated standardization of key messages and patient education protocols, along with adaptation and innovation among multiple community partners. Primary outcome was HbA1c. Secondary outcomes included body mass index (BMI), fasting plasma glucose (FPG), systolic/diastolic blood pressure (SBP/DBP), low-density lipoprotein-cholesterol (LDLc), depressive symptoms (PHQ-8), diabetes distress, and general quality of life (EQ-5D). Results Analyses included 967 participants completing both baseline and follow-up assessment. Intervention communities were older (mean: 66.43 vs. 63.45 years), included more women (57.1% vs. 45.5%), and had longer diabetes duration (mean: 7.95 vs. 6.40 years). Significant improvements were found for HbA1c (7.42%, 58 mmol/mol vs. 7.95%, 63 mmol/mol) as well as BMI (25.31 vs. 25.94 kg/m2), FPG (7.91 vs. 8.59 mmol/L), and PHQ-8 (1.39 vs. 1.41) favoring Intervention communities, adjusting for baseline values of outcome measures and confounders (p levels 0.028). No interactions were found with age (<65, ≥ 65 years). Men showed modestly greater DBP reduction and women showed minor increase of LDLc in Intervention. Theses analyses by age or gender and sensitivity analyses with missing data imputation supported the robustness of findings. Conclusions Culturally adapted and appropriate community-based peer support for diabetes management may improve clinical and psychosocial outcomes at 24 months among those with diabetes.