In 9 Community Health Centers (CHCs) , peer leaders led neighborhood activities, co-led meetings on diabetes management, and followed up with individuals and families, all under the Shanghai Integration Model coordinating primary (CHCs) , hospital, and specialty diabetes care. Previously reported were significant changes in HbA1c, other clinical markers, and diabetes distress from baseline to the end of the active program at 12 months. Changes were pronounced among those exceeding criteria for heightened concern at baseline. Here we report extended impacts for all participants (1009) with baseline and 18-month data, controlling for all individual characteristics. Evaluation indicators and criteria for heightened concern were: HbA1c ≥ 8%, SBP ≥ 130 and DBP ≥ 80 mmHg, LDLc ≥ 2.6 mmol/L, BMI ≥ 26 kg/m2, PHQ8 ≥ - moderate depression, EQ5D quality of life and 4-item measure of diabetes distress - top tertiles. Reductions from baseline to 18 months were significant for HbA1c, SBP and DBP, and PHQ8 depression (ps: 0.00to 0.0088) . Among those exceeding criteria for heightened concern, reductions from baseline to 18-months were significant for all variables (ps ≤ 0.0001) including, e.g., HbA1c from 9.06% to 8.50% (SDs = 0.96, 1.55) . Research staff blinded to outcomes rated implementation of the peer leader program, yielding high- and low-implementation CHCs. For all participants, changes from baseline to 18 months were significantly greater in high- than low-implementation CHCs for HbA1c (p = 0.0246) and SBP (p < 0.0001) . Among those at heightened concern, reductions were greater in high- vs. low-implementation CHCs for HbA1c, SBP and DBP (ps: < 0.0to 0.0073) . Conclusion: Improvements in clinical and quality of life measures following peer leaders promoting diabetes self management as part of the Shanghai Integration Model were sustained over 18 months, especially for those with baseline measures indicating heightened concern and in high implementation CHCs.
Y.Liu: None. W.Jia: None. C.Cai: None. X.Wu: None. P.Y.Tang: None. M.M.Coufal: None. L.Shen: None. Y.Qian: None. S.Luu: None. E.B.Fisher: Advisory Panel; Lilly, Consultant; WellDoc, Research Support; Merck & Co., Inc.
Shanghai Municipal Grants Award (GWIV-3.1) Shanghai Public Health Youth Award (GWV-10.2-YQ24) Shanghai Municipal Health Commission (201940141) Shanghai 6th People's Hospital (ynlc201812) The Merck FoundationSanofi China National Institute of Diabetes and Digestive and Kidney Diseases (P30 DK092926)