Systematic review of healthcare-led and lay-led interventions for type 2 diabetes in community settings

Models led by trained non-professionals or incorporating peer support may serve as promising alternative approaches to address shortages of healthcare personnel and substantial economic burdens. However, no comprehensive meta-analysis has yet evaluated whether models led by non-healthcare professionals and supported by peers can achieve effectiveness comparable to those led by healthcare professionals and without peer support in improving metabolic outcomes. This meta-analysis aims to address this existing knowledge gap. Randomized controlled trials (RCTs) were systematically searched in eight Chinese and English databases from their inception to February 1, 2025. Meta-analyses, subgroup analyses, and sensitivity analyses were performed using RevMan 5.4 and Stata 18.0 software. The quality of evidence for each outcome indicator was evaluated using the online tool GRADEpro GDT. A total of 30 studies were included in the meta-analysis. The findings demonstrated that community-based interventions had a significant effect on improving HbA_1c (MD = - 0.57, 95% CI = - 0.69 to - 0.45, P < 0.00001), 2-h plasma glucose (MD = - 1.68, 95% CI = - 2.24 to - 1.12, P < 0.00001), fasting glucose (MD = - 0.98, 95% CI = - 1.16 to - 0.79, P < 0.00001), total cholesterol (MD = - 0.33, 95% CI = - 0.54 to - 0.11, P = 0.003), triglycerides (MD = - 0.60, 95% CI = - 0.87 to - 0.34 P < 0.00001), and body mass index (MD = - 1.40, 95% CI = - 1.99 to - 0.80, P < 0.00001) in patients with type 2 diabetes.However, the interventions did not lead to significant changes in high-density lipoprotein (MD = 0.06, 95% CI = - 0.01 to 0.13, P = 0.09) or low-density lipoprotein (MD = - 0.33, 95% CI = - 0.94 to 0.28, P = 0.29). Subgroup analyses indicated that interventions led by healthcare professionals were more effective than those led by non-healthcare professionals in improving HbA_1c (subgroup difference P < 0.05). Moreover, peer support was less effective than non-peer support in reducing HbA_1c levels (subgroup difference P = 0.0003). A comprehensive assessment of the quality of evidence included in this study indicates that, despite the substantial sample size, the level of evidence for all outcome measures remains low. Despite the low certainty of evidence, the achievement of clinically meaningful reductions in HbA_1c(approximately 0.30% and 0.26% in subgroup analyses) supports the use of non-professional and peer-support models as pragmatic, second-best alternatives to professional-led care in resource-limited settings.