Researchers studied a diabetes support program called Health Extension for Diabetes (HED) that teaches people how to manage their condition better. Over 1,400 people participated in the program, which included 8 classes led by trained health workers. After completing the program, participants showed real improvements: they exercised more, ate healthier, checked their blood sugar more often, and lost weight. Their knowledge about diabetes increased, and they felt more confident managing their condition. This study shows that community-based programs can be an effective and affordable way to help people with diabetes live healthier lives.

The Quick Take

  • What they studied: Whether a community-based diabetes education program could help people with diabetes improve their self-care habits, knowledge, and overall health.
  • Who participated: 1,526 people with diabetes from rural communities who enrolled in the Health Extension for Diabetes program between 2018 and 2024. Most participants (94%) completed the full program of 8 educational sessions.
  • Key finding: People who completed the program showed meaningful improvements across multiple areas: they exercised more days per week (increased from 2.6 to 3.7 days), ate healthier (improved diet days from 3.9 to 4.7 days per week), lost an average of 3.4 pounds, and their blood sugar control improved (hemoglobin A1c dropped from 7.5% to 7.0%). All improvements were statistically significant.
  • What it means for you: If you have diabetes and live in a rural area, a program like this may help you develop better habits for managing your condition. The program appears to work best as a structured, community-based approach with trained instructors. However, results may vary depending on your individual circumstances and commitment to the program.

The Research Details

Researchers created a diabetes education program called Health Extension for Diabetes (HED) and tracked how well it worked over several years. The program consisted of 8 classes held every two weeks, taught by trained rural health workers with support from a diabetes expert. Participants completed surveys before starting the program, right after finishing it, and again at 1 year and 2 years later. The researchers measured changes in things like exercise habits, diet quality, blood sugar testing, weight, and how confident people felt managing their diabetes. They used statistical tests to determine if the improvements were real and not just due to chance.

This research approach is important because it shows real-world results from actual community programs, not just laboratory studies. By following people for up to 2 years after the program ended, researchers could see if the benefits lasted. The study used a framework called RE-AIM that looks at whether programs reach the right people, actually work, get adopted by communities, are implemented correctly, and continue to work over time. This helps determine if the program could be expanded to other communities.

The study has several strengths: a large number of participants (1,526), a high completion rate (94%), and long-term follow-up data. The researchers measured multiple health outcomes, not just one. However, the study didn’t include a comparison group of people who didn’t take the program, which would have made the results stronger. The study relied partly on self-reported information, which can sometimes be less accurate than objective measurements.

What the Results Show

Participants showed consistent improvements in their diabetes self-care habits. Exercise increased from an average of 2.6 days per week to 3.7 days per week—a meaningful jump of more than one extra day of activity. Healthy eating improved across two measures: general diet increased from 4.1 to 5.0 days per week, and specific diabetes-friendly diet increased from 3.9 to 4.7 days per week. Blood glucose testing (checking blood sugar) improved from 4.2 to 5.2 days per week, and foot care—an important but often-neglected part of diabetes management—increased from 3.4 to 4.6 days per week.

Participants’ knowledge about diabetes management improved significantly, jumping from 76.4% correct answers to 85.0%. Their confidence in managing their diabetes (called self-efficacy) increased from 7.1 to 8.2 on a 10-point scale. These improvements in knowledge and confidence likely contributed to the behavioral changes observed.

Physical health-related quality of life improved from 42.8 to 45.1 on a 100-point scale, and mental health quality of life increased from 51.4 to 52.9. While these may seem like small numerical changes, they represent meaningful improvements in how people felt day-to-day. Weight decreased by an average of 3.4 pounds, and body mass index (a measure of body weight relative to height) decreased from 34.3 to 33.7 kg/m². Most importantly, participants’ self-reported blood sugar control (hemoglobin A1c) improved from 7.5% to 7.0%, which represents better long-term blood sugar management.

The high program completion rate (94%) suggests that the program design was engaging and accessible to participants. The improvements were consistent across different types of self-care activities, indicating that the program had broad effects rather than helping with just one aspect of diabetes management. The fact that participants showed improvements in both physical and mental health quality of life suggests the program addressed the whole person, not just blood sugar numbers.

This study builds on previous research showing that diabetes education programs can improve self-care behaviors and health outcomes. The results are consistent with other community-based diabetes programs, but the long-term follow-up data and the use of trained community health workers make this approach particularly promising. The improvements in hemoglobin A1c (from 7.5% to 7.0%) are comparable to or better than many other diabetes intervention studies, suggesting this community-based approach is competitive with other methods.

The study didn’t include a control group (people who didn’t participate in the program) for comparison, which makes it harder to know how much of the improvement was due to the program versus other factors. The study relied on participants’ self-reported information for some measurements, which can be less accurate than objective tests. We don’t know if the improvements continued beyond 2 years. The program was implemented in rural areas, so results might be different in urban settings. Finally, we don’t have detailed information about which specific parts of the program were most helpful.

The Bottom Line

If you have diabetes and live in a rural community, consider participating in a diabetes self-management support program like Health Extension for Diabetes if one is available. The evidence suggests these programs can help you improve your diet, exercise more, manage your blood sugar better, and feel more confident. Moderate confidence: The improvements shown in this study are real and meaningful, but individual results will vary. Talk with your doctor before making major changes to your diabetes management routine.

This program is designed for people with diabetes living in rural areas who want to improve their self-care habits. It appears to work well for people willing to attend 8 educational sessions over 4 months. People with type 1 or type 2 diabetes may both benefit. This approach may be less suitable for people with severe diabetes complications or those unable to attend regular sessions. The program may need adjustment for people with limited literacy or language barriers.

Based on this study, you can expect to see improvements in your knowledge and confidence fairly quickly—likely within the 8-week program. Physical improvements like weight loss and better exercise habits typically take 2-4 weeks to become noticeable. Blood sugar improvements (hemoglobin A1c) usually take 2-3 months to show up in blood tests because this measurement reflects average blood sugar over the previous 3 months. The study showed benefits continued at least 2 years after the program ended, suggesting lasting effects.

Want to Apply This Research?

  • Track weekly self-care activities in the same way the study measured them: count the number of days per week you exercise, follow a healthy diet, check your blood sugar, and perform foot care. Set a goal to gradually increase each category by one day per week until you reach 5-6 days per week for most activities.
  • Use the app to log daily diabetes self-care activities and receive reminders for the five key behaviors: healthy eating, exercise, blood glucose testing, foot care, and medication adherence. Set weekly goals based on the program’s progression (starting where you are and gradually increasing). Share your progress with your healthcare provider or a diabetes educator.
  • Create a dashboard showing your weekly average for each self-care activity. Compare your current week to previous weeks to see trends. Set monthly check-in reminders to review your progress and adjust goals. If possible, sync with your healthcare provider’s office to share data quarterly. Track how you feel (energy level, mood) alongside your behaviors to reinforce the connection between self-care and quality of life.

This research describes the results of a specific diabetes education program and should not be considered medical advice. Individual results vary, and what works for one person may not work for another. Before making any changes to your diabetes management, diet, or exercise routine, consult with your doctor or healthcare provider. If you have diabetes, work with your healthcare team to develop a personalized management plan. This study was observational in nature and does not prove that the program caused all the improvements observed—other factors may have contributed. Always follow your doctor’s recommendations for blood sugar targets and medication management.