Community-Based Peer Support for Diabetes Management-Impacts Relative to Comparison Communities

Community-based Peer Leader (PL) program in 12 PL communities (PLCs) was compared to 4 Comparison Communities (CCs) in Shanghai, China from 2019 to 2021. Key collaborators included district and sub-district health promotion offices, community health centers (CHCs), community self-management groups, and neighborhood committees. Implementation assessment indicated community adaptation of standardized intervention components: public education about diabetes, neighborhood activities, diabetes education classes, diabetes management meetings, follow-up with individuals and families, and online communication via WeChat due to COVID disruptions. Among those with baseline and follow-up data (n = 1066), PLCs (n = 799) and CCs (n = 267 in 4 CCs) differed significantly on age (66.4 vs 63.7 years), gender (56.8% vs 46.4% female), diabetes duration (8.0 vs 6.5 years), and BMI (25.3 vs 26.0 kg/m2) (all ps ≤ 0.009). Controlling for these and baseline levels of HbA1c, reductions of HbA1c favored the PLCs (-0.06±1.27 vs 0.22±1.56, p < 0.001). Parallel analyses showed significant reductions favoring PLCs for FPG (-0.04±2.50 vs 0.76±2.84, p < 0.001), a 4-item measure of diabetes distress (-0.07±0.41 vs 0.06±0.37, p = 0.004), and depressive symptoms (PHQ-8) (-0.49±3.21 vs 0.54±2.73, p = 0.002). Among those with elevated baseline levels, greater reductions for PLC vs CC were observed for those with HbA1c ≥ 8% at baseline (-0.76±1.56 vs -0.41±2.09, p = 0.038) and those with FPG > 7 mmol/L (-0.54±2.93 vs -0.06±2.95, p = 0.007). Significant PLC vs CC differences were not observed for SBP, DPB, or general quality of life (EQ5D). A slight difference in change of LDLc favored CCs (-0.28±0.90 vs -0.38±0.86, p = 0.042) but only for those with elevated LDLc ≥ 2.6 mmol/L. Community organization of PL for diabetes management implemented through community groups and CHCs showed greater changes in glucose control, diabetes distress, and depressive symptoms compared with comparison groups. Disclosure Y.Liu: None. C.Cai: None. X.Wu: None. P.Y.Tang: None. M.M.Coufal: None. L.Shen: None. E.B.Fisher: Advisory Panel; Eli Lilly and Company, Research Support; Merck Sharp & Dohme Corp. W.Jia: None. Funding Chinese Academy of Engineering (2022-XY-08); Shanghai Municipal Science and Technology Commission (22692114600); Shanghai Municipal Grant (GWIV-3.1); Shanghai Municipal Health Commission (20194Y0141, JKKPYC-2022-12); Merck Foundation; Sanofi China; National Institute of Diabetes and Digestive and Kidney Diseases (P30 DK092926)