Effectiveness of Peer-Based Interventions Among Adolescents with Type 1 Diabetes: A Systematic Review

Introduction: Pediatric type 1 diabetes (T1D) is a common life-long condition that affects adolescents psychologically, socially, and physically due to the necessity of self-management. Adolescents with T1D may be stressed due to their inability to perform self-care activities to control blood glucose levels, adhere to diet management, depression, peer discrimination, anxiety, and eating disorders. Peers play an important role in diabetes management during adolescence. Purpose: The purpose of this systematic review (SR) was to assess the effectiveness of peer-based interventions (PBIs) in improving the health outcomes among adolescents with T1D globally and identify potential future research areas. Methods: The completion of this SR was done using Joanna Briggs Institute (JBI) for SRs as a guide. MEDLINE, CINAHL, PubMed, Web of Science, ProQuest Dissertation and Theses Global, Scopus and PsycINFO databases were searched. The title and abstract of the articles were reviewed using the eligibility criteria. Subsequently, two reviewers screened the full text articles and critically appraised the remaining articles using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. An adapted Pinch Table was used to extract relevant information from the included articles which facilitated data organization, synthesis, and drawing conclusions. The quantitative data were analyzed using narrative synthesis and the findings were reported herein. Findings: The primary finding of this SR was the lack of evidence on the effectiveness of PBIs in adolescents who have T1D. However, three studies were included in this review and, through analysis of the studies, clinical, behavioural, psycho-social, and quality of life (QOL) outcome measures were identified. In this SR, PBIs included peer interaction and group diabetes education, peer education and web-based interactive treatment setting to enhance glycemic control, self-care habits, self-esteem, and adherence. Following the interventions, the authors of three studies found a decrease in HbA1c while other results showed increased self-esteem, social support, knowledge levels, diabetes self-management self-care scores, self-efficacy for diabetes, self-reported adherence, and diabetes-related QOL among adolescent participants. Conclusion: The findings from the three studies included in this review indicated that PBIs are effective in supporting management of T1D and ensuring significant positive health outcomes. These findings can be used by healthcare providers to provide insight into future use and continued development of PBIs for adolescents living with T1D and their families, globally. Future studies including randomized controlled trials and qualitative studies are highly recommended to explore development and evaluation of PBIs.