Peer Support To Enhance The Shanghai Integration Model Of Diabetes Care: Dissemination To 12 Communities

The development of contemporary diabetes care offers new hope for long and satisfying lives of those with the disease, but also provides increased challenges for integration across the many dimensions of care (varied medications in addition to insulin, specialty services, diet, physical activity, stress management, etc.) and across the many who contribute to care (specialists, primary care providers, nurses, dietitians and patient educators, family members, friends, worksites). The Shanghai Integration Model (SIM) has made great strides to integrating specialty/hospital care with primary/community care. The addition of peer support can enhance patient engagement within that integrated care. Peer support can also integrate care with the daily behaviors and patterns that optimal diabetes management requires and with the family members and others in individuals' daily lives who can support diabetes management.

This project will disseminate a community-level intervention that integrates peer support from Community Self-Management Groups (CSMGs) and primary care through Community Health Centers (CHC). The model and program materials were developed and refined from the first year of implementation within community health centers in Shanghai. This project will be implemented in 12 communities in 6 districts across Shanghai, representing a diverse cross section of the population. A total of 1440 subjects will be recruited from the 12 intervention communities and 720 control subjects will be recruited from 4 control communities.

The program is a collaboration among the Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, the Shanghai Diabetes Institute, the National Office for Primary Diabetes Care, the Shanghai Municipal Health Commission, the Shanghai Municipal Center for Disease Control and Prevention, and, at the University of North Carolina-Chapel Hill, Peers for Progress, widely recognized for its leadership in promoting peer support in health care and prevention.

Collaborators:

Shanghai Sixth People's Hospital Shanghai Jiao Tong University Shanghai Diabetes Institute National Office for Primary Diabetes Care Shanghai Municipal Health Commission Shanghai Municipal Center for Disease Control and Prevention University of North Carolina at Chapel Hill, Peers for Progress

Inclusion criteria

• Adults age ≥ 18
• Chinese
• Has type 2 diabetes or prediabetes
• Patient at participating CHC

• Intervention group: 120 subjects at each of 12 CHCs
• ~40 patients (Pre-diabetes including IFG or IGT)
• ~40 patients (Diabetics with poor control, FPG≥9.7 mmol/L)
• ~40 patients (Newly-diagnosed diabetics within 2 years)

• Control group: 240 control subjects at each of 2 CHCs (Yichuan and Zhaoxiang) and 120 control subjects at each of 2 CHCs (Xuhang and Waigang)

o (Yichuan and Zhaoxiang)

• ~80 patients (Pre-diabetes including IFG or IGT)
• ~80 patients (Diabetics with poor control, FPG≥9.7 mmol/L)
• ~80 patients (Newly-diagnosed diabetics within 2 years)

o (Xuhang and Waigang)

• ~40 patients (Pre-diabetes including IFG or IGT)
• ~40 patients (Diabetics with poor control, FPG≥9.7 mmol/L)
• ~40 patients Newly-diagnosed diabetics within 2 years)

Exclusion criteria

• No serious mental illness (i.e. major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder, panic disorder, post-traumatic stress disorder, borderline personality disorder)

Withdrawal criteria:

• No longer a patient at participating CHC (moved, deceased, extended hospitalization)