Effectiveness of Peer Education on Self-Care Behaviors and Glycemic Control in Adolescents with Type 1 Diabetes: Randomized Controlled Trial (RCT)

Nakhaee Moghadam, Maryam; Shafighi Shahri, Elham; Keykhanasab, Mohadeseh

doi:10.22038/jpp.2026.97132.5701

Effectiveness of Peer Education on Self-Care Behaviors and Glycemic Control in Adolescents with Type 1 Diabetes: Randomized Controlled Trial (RCT)

Document Type : original article

Authors

Maryam Nakhaee Moghadam ¹

Elham Shafighi Shahri ¹

Mohadeseh Keykhanasab ²

¹ Children and Adolescents Health Research Center, Research Institute of Cellular and Molecular Science in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran.

² Resident of Pediatric Department, Zahedan University Medical Sciences, Zahedan, Iran.

10.22038/jpp.2026.97132.5701

Abstract

Background: Adolescents with type 1 diabetes (T1D) often struggle with maintaining optimal self-care and glycemic control. Peer education, leveraging support from individuals with similar experiences, is a promising strategy for improving health behaviors in chronic conditions.
Objectives: This study aimed to evaluate the effectiveness of a structured peer education program on self-care behaviors and glycated hemoglobin (HbA1c) levels in adolescents with T1D.
Methods: In a randomized controlled trial, 62 adolescents (aged 12-18 years) with T1D and baseline HbA1c >7.5% were recruited from a single center (Ali Asghar Hospital, Zahedan, Iran) in 2024-2025. Participants were randomized into an intervention group (receiving a 12-week program of four 90-minute peer-led educational sessions) and a control group (receiving routine care). Outcomes were measured at baseline and 12 weeks using the validated Persian version of the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire and HbA1c tests. Data were analyzed using IBM SPSS Statistics (version 26) and included paired and independent t-tests. This research was supported by Zahedan University of Medical Sciences, Zahedan, Iran.
Results: All participants completed the study. The intervention group showed a significant improvement in self-care scores (from 65.7 ± 9.9 to 79.2 ± 11.0, p < 0.001) and a significant reduction in HbA1c levels (from 9.4 ± 1.3% to 8.1 ± 0.9%, p < 0.001). No significant changes were observed in the control group for either outcome.
Conclusions: A structured peer education program significantly improved self-care behaviors and glycemic control in adolescents with T1D within this trial context, suggesting it may be a valuable adjunct to conventional care. However, the findings should be interpreted considering the study's limitations, including its single-center design, relatively

Keywords

Adolescents

Glycemic Control

HbA1c

Peer Education

Self-Care

Type 1 Diabetes

1. Moghadam MN, Mir F, Nourmohammadi J, Shahri ES. Family-Centered Interventions to Enhance Self-Management Among Children and Adolescents with Type 1 Diabetes: A Systematic Review.

2. Gangqiang G, Hua C, Hongyu S. Risk predictors of glycaemic control in children and adolescents with type 1 diabetes: A systematic review and meta‐analysis. Journal of Clinical Nursing. 2024 Jul;33(7):2412-26.

3. Tuomilehto J, Ogle GD, Lund-Blix NA, Stene LC. Update on Worldwide Trends in Occurrence of Childhood Type 1 Diabetes in 2020. Pediatric endocrinology reviews: PER. 2020 Mar 1;17(Suppl 1):198-209.

4. Nourmohammadi J, Lotfi M, Rad MN, Ghaljaei F. Nursing and Family-centered Care and Quality of Life in Children With Diabetic Kidney Disease: A Systematic Review. Journal of Pediatrics Review. 2026 Jan 1;14(1):3.

5. Amini S, Lotfi M, Nazari Rad M, Nourmohammadi J. Exploring the Impact of Educational Interventions on Improving Self-care in Children with Type 1 Diabetes: A Narrative Review. Journal of Pediatric Perspectives. 2025 Nov 1;13(11):19780-7.

6. Dodd S, Widnall E, Russell AE, Curtin EL, Simmonds R, Limmer M, et al. School-based peer education interventions to improve health: a global systematic review of effectiveness. BMC public health. 2022 Dec 2;22(1):2247.

7. Widnall E, Dodd S, Russell AE, Curtin E, Simmonds R, Limmer M, et al Mechanisms of school-based peer education interventions to improve young people’s health literacy or health behaviours: A realist-informed systematic review. PLoS One. 2024 May 31;19(5):e0302431.

8. Maghalian M, Jafarabadi MA, Abbasalizadeh F, Mohammad-Alizadeh-Charandabi S, Ghanbari-Homaie S, Mirghafourvand M. Validation of the Persian version of the summary of diabetes self-care activities scale (SDSCA) in pregnant women with gestational diabetes mellitus using a COSMIN methodology. BMC Endocrine Disorders. 2025 Apr 18;25(1):103.

9. Edraki M, Zarei A, Soltanian M, Moravej H. The effect of peer education on self-care behaviors and the mean of glycosylated hemoglobin in adolescents with type 1 diabetes: a randomized controlled clinical trial. International journal of community based nursing and midwifery. 2020 Jul;8(3):209.

10. Sabagh K, Ghaljaei F, Ghorbani M. Effect of Peer Group Support Educational Intervention on the HgA1c Level and Self-Care Behaviors of Adolescents with Type 1 Diabetes Referred to Zahedan Diabetes Clinics.2024

11. Palladino DK, Helgeson VS. Friends or foes? A review of peer influence on self-care and glycemic control in adolescents with type 1 diabetes. Journal of pediatric psychology. 2012 Jun 1;37(5):591-603.

12. Ng AH, Peng W, Murfet G, Payk M, Barlow S, Lin S. The need for peer support and codesigned services: a qualitative study to understand diabetes education program needs of adolescents with type 1 diabetes. Pediatric diabetes. 2025;2025(1):1843544.

13. Tabernero C, Rebollo‐Román Á, Villaécija‐Rodríguez J, Luque B. Charting a path to health: The empowering influence of self‐efficacy for the self‐management of type 1 diabetes in children and adolescents. International Journal of Psychology. 2024 Dec;59(6):1121-32.

14. Pihlaskari AK, Wiebe DJ, Troxel NR, Stewart SM, Berg CA. Perceived peer support and diabetes management from adolescence into early emerging adulthood. Health Psychology. 2018 Nov;37(11):1055.

15. Malak MZ, Abualruz H, Shehadeh A. Psychosocial factors correlating self-care management among Jordanian adolescents with type 1 diabetes. Journal of Pediatric Nursing. 2025 Jan 1;80:75-82.

16. Patience M, Janssen X, Kirk A, McCrory S, Russell E, Hodgson W, et al. 24-Hour movement behaviours (physical activity, sedentary behaviour and sleep) association with glycaemic control and psychosocial outcomes in adolescents with type 1 diabetes: a systematic review of quantitative and qualitative studies. International Journal of Environmental Research and Public Health. 2023 Feb 28;20(5):4363.

17. Ayamsegna HN, Bally JM, Spurr S, Peacock S. Effectiveness of peer-based interventions among adolescents with type 1 diabetes: A systematic review. Journal of Pediatric Nursing. 2026 Jan 1;86:90-104.

18. Titoria R, Fung A, Tang TS, Amed S. Systematic review of technology‐mediated peer support interventions in paediatric type 1 diabetes care. Diabetic Medicine. 2023 Oct;40(10):e15172.

19. Kazemi S, Parvizy S, Atlasi R, Baradaran HR. Evaluating the effectiveness of peer-based intervention in managing type I diabetes mellitus among children and adolescents: A systematic review. Medical Journal of the Islamic Republic of Iran. 2016 Nov 19;30:442.

20. Hariton E, Locascio JJ. Randomised controlled trials—the gold standard for effectiveness research. BJOG: an international journal of obstetrics and gynaecology. 2018 Jun 19;125(13):1716.

21. Hodgson EE, Wilson SM, Moore JW. Changing estuaries and impacts on juvenile salmon: A systematic review. Global change biology. 2020 Apr;26(4):1986-2001.

22. Granado-Casas M, Sola I, Hernandez M, Rojo-Lopez MI, Julve J, Mauricio D. Effectiveness of medical nutrition therapy in adolescents with type 1 diabetes: a systematic review. Nutrition & Diabetes. 2022 Apr 22;12(1):24.