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

March 31, 2026 updated by: Halefom Kahsay Haile, Addis Ababa University

Effect of a Peer Support Intervention on Glycemic Control and Economic Burden Among Patients With Diabetes on Follow-up at a Tertiary Hospital: A Randomized Controlled Trial

Diabetes imposes a growing global burden due to rising care costs and reduced quality of life from its complications. Managing the disease remains challenging for many patients, highlighting the need for effective, scalable support strategies. Peer support has shown promise in improving diabetes self-management, yet evidence from randomized trials in Ethiopia, particularly on both clinical and economic outcomes, is limited. Thus, this study aimed to evaluated the effect of a peer support intervention on glycemic control and economic burden among patients with diabetes.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

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.

Study Type

Interventional

Enrollment (Actual)

100

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Ethiopia
    • Tigray
      • Mek'ele, Tigray, Ethiopia, 50
        • Ayder comprehencive Specialized Hospital(University Hospital)

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Clincal Diagnosis of Diebetes mullites's Disease
  • Must be on at least one diabetes medication
  • Must had at least two concicative follow-up visits at the Diabetes clinic

Exclusion Criteria:

  • Declined to participate in any of the group
  • Concurrent endocrine disorders (thyroid disease, obesity, or gestational diabetes)
  • Chronic diseases (cardiac heart failure, hepatitis and cancer)
  • Enrollement in other educational programs during the study period those who Health professionals with diabetes

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
No Intervention: Control Group
Standard Care Alone(Control group) Participants continue with routine follow-up and standard diabetes care only.
Active Comparator: Intervention Group

Participants receive peer-led support sessions in addition to usual diabetes care.Behavioral: Structured Diabetes Education on Glycemic control Lived-experience facilitation, goal setting, real-world problem solving, and ongoing peer accountability not provided in standard clinician-led education. Peer-led, group-based sessions emphasizing lived experiences, problem-solving, and mutual support.

Other Names:

• Structured Diabetes Education on Diabetes definition, sign and symptoms and management
Behavioral: Peer led educational intervention program
Structured Diabetes Education on Diabetes definition, sign and symptoms and management

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Glycemic control
Time Frame: Baseline and 6 months
Measured using HbA1c change between the groups
Baseline and 6 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
peer support Implmentation cost
Time Frame: 6 months
Evaluating the cost expensed for the implementation of peer support program for the consecutive three rounds
6 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Addis Ababa University

Investigators

  • Principal Investigator: Halefom Kahsay Haile, Msc, Addis Ababa University
  • Study Director: Teferi G Fenta, Professor, Addis Ababa University
  • Study Chair: Bruck M Habte, A. Professor, Addis Ababa University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

December 1, 2024

Primary Completion (Actual)

July 30, 2025

Study Completion (Actual)

August 30, 2025

Study Registration Dates

First Submitted

March 24, 2026

First Submitted That Met QC Criteria

March 24, 2026

First Posted (Actual)

March 30, 2026

Study Record Updates

Last Update Posted (Actual)

April 6, 2026

Last Update Submitted That Met QC Criteria

March 31, 2026

Last Verified

March 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • AAU-SoP
  • 084/24/SoP (Other Identifier: Addis Ababa University)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Currently, our data needs clearance,organization and documentation

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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