Background Peer support has been recognised as a promising strategy to improve self-management in patients living with chronic conditions, such as Type 2 diabetes (T2D). The purpose of the review was to synthesise the best available evidence on face-to-face peer support models for adults with T2D in low and middle-income countries (LMICs). Methods We searched Medline, Cumulative Index to Nursing and Allied Health, Literature Academic Search Ultimate, PsycINFO, CAB Abstracts, Health Source: Nursing/Academic Edition, SPORTDiscus, Africa-Wide Information, MasterFILE Premier, SocINDEX, ERIC, PsycARTICLES, Open Dissertations, Communication & Mass Media Complete, Health Source-Consumer Edition and Google Scholar for the period January 2000 to December 2017. Reference list checking and contact with authors were additional sources of data. Screening of papers, critical appraisal and data extraction were carried out independently by at least two reviewers. Results From 3092 abstracts retrieved from database searches, data was extracted from 12 papers. There was no consistency in design, setting, outcomes or measurement instruments amongst the papers. The papers were associated with improvements in various clinical and behavioural outcomes. Diabetic patients and community health workers (CHWs) were identified as two common face-to-face peer support models. The recruitment and selection of diabetic patients as peer supporters focused on patients from the community, with good glycaemic control and/or leadership skills, who were recommended by healthcare professionals. Recruitment of CHWs as peer supporters was done from an existing infrastructure of CHWs in the community and, thus, selection criteria were poorly described. The training of peer supporters featured as an important component, highlighting who provided training and the duration and content covered in training. Motivational interviewing was the most common theory basis of training used in the peer support interventions. Face-to-face, group and/or individual-based peer support was often supplemented by other peer support methods. The supervision of peer supporters was generally poorly described. Conclusions The comprehensive synthesis of the best available evidence has led to new insights regarding face-to-face peer support as a self-management strategy for patients with T2D in LMICs. Face-to-face peer support may be implemented in innovative ways to improve the quality of life of patients with T2D. Trial registration PROSPERO trial registry number, CRD 42018103261.

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To establish the impact of a face-to-face peer-support intervention on adults with type 2 diabetes in South Africa. Methods: A cluster randomised controlled trial was conducted involving 288 adults with type 2 diabetes from six communities in the Free State province. Individuals (n = 141) in three communities were randomly allocated to the intervention group, and individuals (n = 147) in another three communities were randomly allocated to the control group. Trained community health workers led monthly group sessions and home visits. The control group received the usual care. The primary outcome of the study was glycated haemoglobin (HbA1c), measured at baseline and endpoint after four months. Secondary outcomes included blood pressure, body mass index and waist circumference, measured at baseline and endpoint. Descriptive statistics were calculated per group. Results: No significant changes from baseline were found between groups regarding HbA1c (p = 0.87), body mass index (p = 0.21), waist circumference (p = 0.24) and systolic blood pressure (p = 0.13). Compared with the control group, the intervention group had a significant improvement in diastolic blood pressure (p = 0.02). Conclusions: The face-to-face peer-support intervention delivered by trained community health workers in a semi-urban rural area resulted in a significant improvement in diastolic blood pressure of adults with type 2 diabetes.

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Background Self-management is the backbone of diabetes care. For the patient with type 2 diabetes, this implies making decisions about a healthy diet, regular exercise and taking treatment appropriately. Some patients may experience barriers to the self-management of diabetes, such as lack of support. In this respect, peer support has been identified as a promising strategy in the self-management of diabetes. Aim The study aimed to explore the experiences of adults with type 2 diabetes who took part in a diabetes peer support intervention in the Free State, South Africa. Such information may lead to the development of practical methods for diabetes self-management and control. Methods Twelve purposively sampled Sesotho-speaking women (aged 51–84 years) participated in the Mmogo-method®, a visual-based narrative enquiry. Textual data from audio recordings of discussions, visual data from photographs of constructions and field notes were triangulated and analysed thematically. Results Participants described the peer support intervention as very valuable. They regarded community health workers as an important source of support. Three themes emerged from the intervention: positive lifestyle changes, continuous support, and improved confidence and sense of connectedness. This was a significant finding reported in patients with diabetes, as it will contribute to successfully sustaining effective self-management behaviour. Conclusions Peer support for patients with type 2 diabetes appeared to be a valued intervention, as participants related well to community health workers, who are ideally positioned in the healthcare system to provide the service.