Community health worker intervention to prevent incident type 2 diabetes: A cluster randomized trial

Type 2 diabetes mellitus (T2DM) affects millions of Americans, and prediabetes significantly increases progression to T2DM. Community Health Workers (CHWs) may help prevent diabetes through behavioral interventions, but their effectiveness in real-world settings remains uncertain. We evaluated whether a CHW intervention prevents incident T2DM among adults with prediabetes.

Pragmatic, cluster-randomized controlled trial in primary care clinics at the Veterans Affairs NY Harbor Healthcare System (Manhattan) and Bellevue Hospital, New York City. The study included adults aged 18-75 years with HbA1c 5.7-6.4% and no prior diabetes or use of diabetes medications other than metformin. Primary care teams were cluster-randomized to a 12-month CHW program-health action plans, motivational interviewing, health education, and community referrals-versus usual care. The primary outcome was incident diabetes during up to 6 months' follow-up after the 12-month intervention. Secondary outcomes were changes in HbA1c, weight, blood pressure, lipids, and health care utilization.