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Researchers from the UNC Gillings School of Global Public Health and Peers for Progress have collaborated with colleagues in Shanghai on a paper showing the contributions of peer support to diabetes management, published today in Translational Behavioral Medicine. This paper is part of a special section of the journal devoted to prevention and management of diabetes in varied international settings – China, India, South Africa, Sweden and Uganda.

If the 463 million people across the globe with diabetes were a country, they would constitute the third-largest in the world, behind India and China but well ahead of the United States. This represents dramatic increases in the percentages of people with diabetes – many of whom do not know they have the disease – and reflects parallel increases in obesity around the world. The continued growth of diabetes, along with other chronic diseases, is most dramatic in low- and middle-income countries, but it threatens to overwhelm even upper-income countries’ capacity to provide health care to their citizens.

The “Shanghai Integration Model” brings together specialty/hospital with primary/community-based care for people with diabetes. This provided the setting for development of peer support programs in collaboration with Shanghai Jiaotong University-affiliated Sixth People’s Hospital.  Implemented through community health centers, peer supporters encouraged those with diabetes to adopt good health habits, which included prescription medication compliance, healthy diet, physical exercise, seeking community support for emotional well-being, and routine primary and specialty care. Benefits included improved blood sugar control, especially among those with initially high blood sugar levels.

Edwin Fisher, professor of health behavior at the Gillings School and global director of Peers for Progress noted that “the results add to those of many other studies, showing that peer support has a real, constructive role to play in helping people with diabetes and other chronic health problems.”

Benefits of the peer support program varied, however, according to how extensively the Community Health Centers were able to support and implement the program. A current phase includes both health centers and other organizations in the community to bring further support for the program. These include community health promotion offices and citizen-led “Community Self-Management Groups,” of which there are more than 5,000 in Shanghai.

The Shanghai government has designated peer support as a key strategy, and it has identified this program as a model for achieving 2030 goals for self-management of diabetes and other chronic diseases.

“The complexity of diabetes can be difficult for people to grasp. Peer supporters can help people put it all into practice,” commented Weiping Jia, director of China’s National Office for Primary Diabetes Care and leader of the Shanghai Integration Model. “Now, the endorsement of the Shanghai government can really accelerate dissemination, not only in Shanghai but also as a model for the rest of China and other countries.”

What is perhaps most important in this paper – and in all the papers in the special section of the journal – is that they focus not on better medicines for diabetes but on helping individuals develop good habits to maintain a healthy lifestyle. The programs they report are based both in traditional health services and in communities and neighborhoods involving individuals and groups of friends and neighbors that provide assistance and encouragement to improve health outcomes.

Major challenges for more effective, better disseminated and better-supported programs lie ahead. The Shanghai paper and others in the special section demonstrate how core program strategies for prevention and management of diabetes may be adapted and successfully implemented in clinics and among neighborhoods and communities in diverse and often resource-constrained settings around the world.

The paper on the UNC-Shanghai collaboration, as well as the other papers of the special section, are available at the journal’s website.

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