Community-Based Models for Type 2 Diabetes Care: A Review of Effectiveness, Implementation, and Health System Integration.

INTRODUCTION

Type 2 diabetes mellitus (T2DM) presents a major challenge in low- and middle-income countries (LMICs) due to workforce shortages, limited primary-care capacity, and fragmented chronic-care delivery. Community-based diabetes care models have emerged as scalable approaches to strengthen self-management and extend service reach. With this background, we aimed to synthesize global evidence on community-based diabetes care models, classify major intervention typologies, examine their alignment with the diabetes care continuum, and assess their effectiveness and implementation characteristics.

METHODS

A narrative review was conducted using a structured search of PubMed, Scopus, Web of Science, and Embase for studies published between January 2010 and March 2025. Eligible studies focused on community-based T2DM interventions delivered by community health workers (CHWs), peer educators, or digital-community hybrids. Interventions were categorized and mapped across the diabetes care continuum, and evaluated using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, as well as complementary integration models.

RESULTS

Eleven studies were included, in which peer-led models were common in high-income countries, while CHW-led and hybrid models were predominant in LMICs. Interventions demonstrated clinically significant improvements in glycated hemoglobin (HbA1c), BMI, and self-efficacy. Successful models embedded within existing public health systems or culturally rooted community platforms showed higher adoption and long-term maintenance. Digital interventions enhanced reach, but faced challenges with sustained engagement and infrastructure support. The RE-AIM analysis revealed strong effectiveness and reach; however, long-term maintenance and adoption varied based on the level of contextual integration and supervision structures.

CONCLUSION

Community-based T2DM care models offer scalable, sustainable strategies to improve disease control. Integration into national health platforms, supportive supervision, and digital augmentation enhance implementation success. Challenges persist in follow-up, cost-effectiveness, and equity design; scale-up should prioritize integration, financing, and CHW capacity.