Effect of a Peer Support Intervention on Glycemic Control and Economic Burden Among Patients With Diabetes

Globally, diabetes poses a growing challenge for health systems and communities, largely due to escalating care costs and the decline in quality of life associated with its chronic complications. Regardless of therapeutic advancements, managing diabetes to achieve strict glycemic control over the long term is still difficult long term basis remains complicated and ponderous, which in case of failure leads to inadvertently poor cardiovascular and microvascular outcomes. A healthy lifestyle, appropriate diet, and medication adherences among diabetic patients are essential factors to the prevention of diabetic complications as well as maintain good glycemic control. However, many patients with diabetes fail to prevent diabetes due to the complex nature of the disease and its management. Hence, patients with diabetes need self-management education to assist them in comprehending and dealing with the disease. Peer support is considered a promising, feasible, and culturally appropriate enhancement to diabetes care which recently has been found as a potential resource for diabetes self-management. It is effective for preventing the complications of diabetes and enhancing health outcomes in patients with diabetes.

Despite advances in therapy, achievement of glycemic targets remains an unmet need in a substantial proportion of patients with diabetes. According to reports from the healthcare effectiveness data and information set in United States of Amarica (USA), Hemoglobin A1C(HbA1C) \<7.0% (53 mmol/mol) is only reached by roughly 40% commercially insured populations and 30% of diabetic individuals in the Medicaid. These figures suggest that despite advanced treatments, many individuals struggle to meet their glycemic targets. The clinical effectiveness of peer support in improving glycemic control has been supported by ubiquitous research findings. A meta-analysis of 13 randomized controlled trials found that peer support interventions reduce HbA1c by a mean of -0.57% (95% CI -0.78 to -0.36) compared to usual care. Importantly, the benefit was greater in interventions with moderate or high contact intensity, whereas low frequency programs showed no significant effect.Another meta-analysis of 17 studies showed a smaller but still significant HbA1c improvement of approximately 0.24% (95% CI 0.05-0.43) in peer support groups versus controls.

These findings underline both the potential and the variability in the efficacy of peer-support strategies in diabetes care. Similarly , a study conducted in Uganda showed that improvements of HbA1c level, after peer support program had carried out to diabetic patients and concluded that as it is a workable intervention to enhance diabetes care in health care settings. In Ethiopia, fewer than 50% of diabetic individuals obtain proper diabetes care . The lack of access to diabetes education and blood glucose monitoring in the nation results in insufficient control of hyperglycemia, which is frequently linked to poverty and treatment discontinuation for a variety of social and economic reasons. About 95% of patients with diabetes mellitus do not self-monitor their blood glucose levels at home, 33% do not consistently take their medications, and 75% need to be admitted to the hospital either directly or indirectly as a result of uncontrolled diabetes. To encourage diabetes self-management, an intensive one-to-one session led by physicians, dieticians, and social workers was delivered and found effective in a variety of health care settings. However, such approaches are difficult to scale in routine care within low and middle income countries (LMICs), where diabetes is highly prevalent and the supply of specialized health professionals is limited. In these settings, peer support offers a practical option to help individuals adopt and maintain healthier behaviors and addressing the burden of diabetes.

In addition to clinical benefits, any decision regarding the adoption of a healthcare program in a resource constrained health system will depend upon its expected economic implications that is, on whether it generates improvements in patients' health at an acceptable cost. Diabetes puts a significant financial burden on patients in Ethiopia and other low-resource settings because of high out-of-pocket costs, insufficient insurance coverage, and the high cost of necessary medical care. A cross-sectional study in the Southwest Shewa Zone found that the mean monthly cost of diabetes care was USD 37.7, with direct costs accounting for over 75% of the total burden. Another study in Addis Ababa reported a median direct monthly cost of USD 21.8 per diabetes patient, as well as significant productivity losses by patients and caregivers. These financial pressures limit access to consistent diabetes care and may worsen its complication. While cost-benefit analyses of peer support intervention have been under-reported in many health care settings, some data suggested that it can reduce costs. International evidences like the United kindome-based randomized controlled trial found the annual implementation cost of peer support per participant was only £13.84 and concluded that providing peer support intervention for patients with diabetes has a benefit not only improved clinical outcomes but also generated net cost savings by decreasing the amount of healthcare services used per participant. Similarly, a trial from Austria found that group-based peer support participants were hospitalized for a shorter duration than controls, which resulted in a cost savings of approximately €1,660 per patient during the first two years of treatment. Given these findings, peer support appears to be a potentially cost-saving, scalable approach.

Although the positive findings from these studies are promising, there have been limited numbers of randomized controlled trials that evaluate the effects of peer support on both the clinical outcome and its comprehensive economic feasibility on patients with diabetes. The relevance of understanding how peer support positively affects patients' direct economic burdens is not just those associated with the health care delivery systems but it has special significance for LMICs, in which out-of-pocket expenditures represent a major impediment to receiving medical care. As to the effect of peer support on glycemic control, there have been many studies on the relation between peer support and glycemic control effect among patients with diabetes but the results of different trials have not been altogether consistent. Additionally, there is no guideline for the implementation of peer support specifically in low-resource environments, like Ethiopia health care settings. Therefore, this study reports the effects of peer support educational intervention on glycemic control and its economic implications on patients with diabetes.