Up to one third of Americans have prediabetes, a condition of elevated glucose levels linked with greater diabetes incidence. Strong evidence shows that peer support is an effective strategy to improve outcomes for people with diabetes; however, no studies have examined whether peer support can be leveraged to improve outcomes in people with prediabetes. The “Using Peer Support To Aid in Prevention and treatment of Prediabetes (UPSTART) ” study is a pragmatic randomized controlled trial at Kaiser Permanente Northern California and the University of Michigan that randomized 351 people with prediabetes (A1c 5.7-6.4; BMI >25 or BMI >23 for Asian patients) from 10/19/2018-3/31/2021 to one of two study arms: a peer support intervention with 1:1 matching of prediabetes patients with coaches trained in motivational interviewing (intervention group) ; or enhanced usual care (control group) . All participants received information on healthy eating, active living, wellness, and diabetes prevention programs. Lifestyle and psychosocial factors were measured via baseline and six-month surveys. In our sample, 2of study patients were female; 1were Black; 147 were White; 31 were Hispanic/Latino; 30 were Asian; 24 were Multiracial or ‘Other’ race. At six months, intervention participants had higher participation in diabetes education and prevention programs (25.2% vs. 11.1%, p=.002) ; higher Patient Activation Measure (PAM) scores (68.9 vs. 65.7 on a 0-100 scale, p=.043) ; greater perceived social support (55.3 vs. 49.6 on a 12-72 scale; p<.001) ; and greater whole grain consumption (19.2 vs. 14.5 days out of 30; p=.024) compared to controls. There were no differences in physical activity, vegetable, fruit, or soda consumption at six months. A peer-support program for people with prediabetes has a positive impact on factors linked to diabetes prevention and better health outcomes. Future research from this study will examine whether the intervention and these improvements are also associated with decreased A1c and weight.


J.Schmittdiel: None. H.Finertie: None. L.A.Rodriguez: None. T.Thomas: None. P.Sanchez: None. M.Heisler: n/a.


National Institutes of Health (R18DK113403)

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