Community health worker intervention to prevent incident type 2 diabetes: A cluster randomized trial
- 1Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America.
- 2Department of Medicine, VA New York Harbor Healthcare System, New York, New York, United States of America.
- 3Department of Medicine, NYU Grossman School of Medicine, New York, New York, United States of America.
Abstract
Objective: 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. Research design and methods: 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. Results: Incident diabetes occurred in 5.9% of intervention patients versus 4.3% of controls (risk difference 1.6%; 95% CI −3.68% to 4.10%). No significant differences were observed in HbA1c, weight, blood pressure, or lipids. The intervention group had more primary care encounters (77.6% vs 62.5%) and emergency department encounters (35.0% vs 29.1%). Conclusions: In this pragmatic trial, a 12-month CHW program did not reduce incident diabetes among adults with prediabetes but was associated with greater health care engagement (more primary care visits). More intensive or standardized CHW models should be tested to determine whether increased engagement translates into long-term metabolic benefit. Trial registration: The study protocol was registered at ClinicalTrials.gov (NCT03006666, 12/27/2016). https://clinicaltrials.gov/study/NCT03006666.
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BibTeX
@article{schwartz2026community,
title = {{Community health worker intervention to prevent incident type 2 diabetes: A cluster randomized trial}},
author = {Mark D Schwartz and Jiyuan Hu and Scott E Sherman and Radhika Gore and Natalie Levy and Michael Tanner and Michael Bergman and Nadia Islam},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0361464},
url = {https://doi.org/10.1371/journal.pone.0361464},
note = {CC0},
}
RIS
TY - JOUR
TI - Community health worker intervention to prevent incident type 2 diabetes: A cluster randomized trial
AU - Mark D Schwartz
AU - Jiyuan Hu
AU - Scott E Sherman
AU - Radhika Gore
AU - Natalie Levy
AU - Michael Tanner
AU - Michael Bergman
AU - Nadia Islam
PY - 2026
DA - 2026/10/30
JO - PLOS One
DO - 10.1371/journal.pone.0361464
UR - https://doi.org/10.1371/journal.pone.0361464
AB - Objective: 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. Research design and methods: 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. Results: Incident diabetes occurred in 5.9% of intervention patients versus 4.3% of controls (risk difference 1.6%; 95% CI −3.68% to 4.10%). No significant differences were observed in HbA1c, weight, blood pressure, or lipids. The intervention group had more primary care encounters (77.6% vs 62.5%) and emergency department encounters (35.0% vs 29.1%). Conclusions: In this pragmatic trial, a 12-month CHW program did not reduce incident diabetes among adults with prediabetes but was associated with greater health care engagement (more primary care visits). More intensive or standardized CHW models should be tested to determine whether increased engagement translates into long-term metabolic benefit. Trial registration: The study protocol was registered at ClinicalTrials.gov (NCT03006666, 12/27/2016). https://clinicaltrials.gov/study/NCT03006666.
SN - 1932-6203
ER -