Leveraging Interventions for Needs and Knowledge in Diabetes (LINKD) (LINKD)

Inclusion Criteria:

Participants:

• Age: 18 years of age or older
• Diabetes diagnosis: Documented diagnosis of diabetes (Type 1 or Type 2) with prescribed anti-hyperglycemic medication
• Glycemic control: Most recent (within the past 6 months) recorded hemoglobin A1c (HbA1c) level of: ≥7.5% for individuals ≤70 years of age and ≥8.0% for individuals between 70-75 years of age Prior study participation: Did not participate in the CareAvenue trial (R01DK116715)
• Financial burden and/or social needs (meeting ONE or more of the following):

Positive report of financial burden using validated screening questions; Medicaid or dual Medicare/Medicaid coverage; Income ≤250% of the federal poverty level; Self-identified as ALICE (Asset-Limited, Income-Constrained, Employed): income above Medicaid threshold but reporting difficulty affording basic needs; Underinsured: high-deductible plan (≥$1,500 individual/$3,000 family) with self-reported difficulty affording healthcare costs; Positive screen for one or more social risk factors on PRAPARE or equivalent (food insecurity, housing instability, transportation barriers, utility insecurity);

• Financial decision-making: Self-identifies as primarily responsible for making own healthcare financial decisions (to address concerns about young adults dependent on family support).
• Interest in assistance: Expresses interest in receiving assistance with unmet social needs.
• Ability to participate: Able to complete the screening process in English (or Spanish/Arabic if materials available) on behalf of self.
• Healthcare access: Receives or is able to receive care at Michigan Medicine (required for potential social worker referral).

Peer Supporters:

• Age: 18 years of age or older
• Diabetes diagnosis: Self-reported diagnosis of diabetes (Type 1 or Type 2)
• Glycemic control: Within the past 12 months, have had at least one hemoglobin A1c (HbA1c) level of: ≥7.5% for individuals ≤70 years of age and ≥8.0% for individuals ≥71 years of age AND A1c levels <7.5% for individuals ≤70 years of age and <8.0% for individuals ≥71 years of age
• Experience navigating social or financial resources: Self-reported success in navigating financial assistance or social services resources
• Ability to participate: Able to provide peer support in English (option to additionally provide support in Spanish and/or Arabic); Able to complete training; Able to make calls every other week with assigned participants; Able to submit call logs; Able to complete a brief survey about experience throughout participation.
• Confidence in diabetes self-management: Self-reported confidence in ability to manage diabetes

Exclusion Criteria:

Participants:

• Serious psychiatric disorder: Active diagnosis of schizophrenia, active psychosis, or other serious mental illness that would impair ability to engage in intervention (as determined by medical record review)
• Cognitive impairment: Documented moderate to severe cognitive impairment that would prevent meaningful participation in study activities (as determined by medical record review)
• Active substance use: Current active illicit drug use that would interfere with study participation (as determined by medical record review)
• Pregnancy: Currently pregnant or planning pregnancy during the study period (due to expected A1c changes) (as determined by medical record review)
• Glucose-altering medications: Currently taking medications that alter glucose metabolism as a side effect rather than for diabetes management, including: Chronic oral corticosteroids (≥2 weeks continuous use); Antipsychotic medications known to affect glucose; Other medications affecting glucose when NOT prescribed for diabetes management Note: GLP-1 agonists, SGLT2 inhibitors, and other diabetes medications are NOT excluded, regardless of whether they are also used for weight management
• Limited life expectancy: Self-reported or documented comorbidity expected to limit life span to less than 3 years
• Concurrent diabetes study participation: Currently enrolled in another diabetes intervention study
• Institutionalized: Currently residing in a nursing home, assisted living facility, correctional facility, or another group setting that prevents them from participating on their own behalf

Peer Supporters:

• Cognitive impairment: Self-reported cognitive impairment that would prevent meaningful participation in study activities
• Participation Concerns or Barriers: Self-reported concerns that would prevent meaningful participation in study activities
• Limited life expectancy: Self-reported or documented comorbidity expected to limit life span to less than 3 years
• Institutionalized: Currently residing in a nursing home, assisted living facility, correctional facility, or another group setting that prevents them from participating on their own