Improving Outcomes for Black Adults with Diabetes: The Power of Peer Support in the Multidisciplinary Care Team

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Abstract
Black adults experience diabetes complications and mortality in disproportionate rates in the United States, with barriers to care driven by factors such as limited access to quality healthcare, socioeconomic disparities, racial discrimination contributing to mistrust and health misperceptions, and social determinants of health such as food insecurity. Poor diabetes outcomes occur, in part due to insufficient access to novel diabetes medications and technologies, and low participation in diabetes management education programs. Within care teams across various healthcare settings, limited health literacy, and poor patient-provider communication, often influenced by implicit bias, further hinders effective diabetes management. Peer support, especially when integrated effectively into a multidisciplinary care team, is a promising approach to address these challenges. Peer supporters, individuals with shared lived experience and cultural backgrounds can foster trust, translate medical guidance in lay terms, and provide ongoing and sustained emotional, social, and tangible support. Peer-led interventions reduce diabetes distress and improve self-efficacy, medication adherence, and clinical outcomes, especially when tailored for Black adults. To effectively integrate peer supporters into care teams, defined roles, structured workflows, and strategically engaging them in patient care planning and team meetings is needed. Comprehensive and robust training, certifications, and continuing education ensure their competence, while maintaining role authenticity. Visibility within clinic and healthcare spaces, role clarity, administrative support, funding and continuous evaluation enhance the sustainability of peer supporters. Facilitators of their role include policy advocacy and funding avenues including Medicaid and Medicare reimbursements. Future efforts should focus on policy reforms to address structural inequities, support the expansion of peer supporters within care teams, including focused roles to thrive professionally, and establish sustainable models through participatory designs and robust evaluations. To address diabetes inequities in Black adults, culturally tailored peer support within multidisciplinary teams is critical, requiring collaborative engagement of healthcare systems, communities, and policy makers.

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