The effect of peer support in diabetes self-management education on glycemic control in patients with type 2 diabetes: a systematic review and meta-analysis

OBJECTIVES: Diabetes self-management education (DSME) programs are a strategy to maintain healthy behaviors. Nevertheless, limited evidence has been reported from systematic evaluations of the effects of DSME integrated with peer support on glycemic control. This study aimed to review the effectiveness of DSME interventions integrated with peer support on glycemic control in patients with type 2 diabetes. METHODS: A systematic search was carried out in electronic databases, including PubMed, Cochrane Library, ProQuest, SpringerLink, ScienceDirect, Scopus, and Google Scholar, for English-language articles published from 2005 until 2020. The effect size was estimated as the standard mean difference (SMD). The Cochrane Collaboration's Risk of Bias tool was employed to assess the risk of bias. RESULTS: Twelve studies were included in this study. DSME integrated with peer support effectively reduced glycated hemoglobin A1c (HbA1c) levels, with a statistically significant effect (SMD, -0.41; 95% confidence interval [CI], -0.69 to -0.13; p< 0.001). Programs with a sample size < 100 (SMD, -0.45; 95% CI, -0.79 to -0.11; p= 0.009), duration of intervention <= 6 months (SMD, -0.52; 95% CI, -0.96 to -0.07; p= 0.020), baseline HbA1c < 8.5% (SMD, -0.42; 95% CI, -0.77 to -0.07; p= 0.020), delivery by group (SMD, -0.28; 95% CI, -0.51 to -0.06; p= 0.010), and high frequency of contact (SMD, -0.29; 95% CI, -0.48 to -0.10; p= 0.003) had statistically significant effects on reducing HbA1c levels in patients with type 2 diabetes. CONCLUSIONS: DSME integrated with peer support effectively enhances glycemic control in patients with type 2 diabetes. Programs with smaller participants groups, shorter interventions, weekly meetings, and closer group sessions improved glycemic control in patients with type 2 diabetes.