Published Apr 18, 2026 | 9:40 AM ⚊ Updated Apr 18, 2026 | 9:40 AM
India has more than 101 million people living with diabetes. (iStock)
Synopsis: The Kerala Diabetes Prevention Programme tasked trained local peer leaders, one man and one woman from each neighbourhood cluster, to run monthly group sessions over 12 months. Their conversations covered familiar ground: eat better, move more, sleep enough, cut back on tobacco and alcohol. A study based on the initiative says that community-led, peer-supported lifestyle programmes can reduce the risk of developing type-2 diabetes.
More than 800 million people worldwide are living with diabetes. Another 500 million are on the brink of getting the disease. Three-quarters of them live in countries like India, where specialist clinics are few, drugs are expensive, and the waiting rooms are perpetually full.
So what if the answer wasn’t a drug at all? What if it was a neighbour?
A nine-year study, published in The Lancet Global Health, has offered a rare and quietly compelling piece of evidence from the real world. It says that community-led, peer-supported lifestyle programmes can reduce the risk of developing type-2 diabetes, even in resource-stretched settings. The benefits can last nearly a decade.
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The Kerala Diabetes Prevention Programme (K-DPP) recruited more than 1,000 adults aged 30 to 60 across 60 community clusters in Kerala. All were identified as being at high risk for diabetes. Half were assigned to a peer-support programme. The other half received a booklet.
The programme itself was deliberately low-tech. Trained local peer leaders, one man and one woman from each neighbourhood cluster, to run monthly group sessions over 12 months. The conversations covered familiar ground: eat better, move more, sleep enough, cut back on tobacco and alcohol.
No hospital visits. No prescriptions. No specialists flown in from the city. Just people from the same neighbourhood, speaking the same language, working through the same challenges together.
Community engagement was woven into every layer of the design. Local self-government institutions, including elected panchayat representatives, helped mobilise participants, provide venues, and lend the programme a credibility that outside organisations rarely command.
The peer leaders themselves were selected from among the participants, intervening as much as a community endeavour as a scientific one.
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After nine years, 30% of those in the intervention group had developed diabetes, compared to 34% in the control group. The four-percentage-point difference did not cross the threshold of statistical significance on its own, meaning it could, in theory, have occurred by chance.
But dig a level deeper, and the picture sharpens considerably. When diabetes was assessed using fasting blood sugar levels alone, the intervention group had a 28% lower risk of developing the condition. The result was statistically significant.
“Although modest, the reduction indicates that even low-intensity, peer-led interventions can have lasting public health impact,” the authors wrote, adding that this was especially relevant “in low- and middle-income countries where access to intensive medical programmes is limited.”
The 28% low-risk figure is not just locally significant. It is, notably, comparable to the effect sizes seen in the landmark US Diabetes Prevention Program, one of the most cited and heavily resourced trials in the field. The difference is that the US program ran on specialist staff, clinical infrastructure, and substantial funding. The K-DPP ran on neighbours.
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The significance of these findings lies not just in the numbers, but in what they represent. Most major diabetes prevention trials were conducted in high-income countries, under tightly controlled conditions, with intensive clinical support.
Evidence from low- and middle-income settings, and particularly from trials that follow participants for more than two or three years, has been scarce.
“Evidence on the long-term effectiveness of lifestyle interventions for diabetes prevention in low-income and middle-income countries is scarce,” the authors noted. The K-DPP, with its nine-year follow-up and 86% participant retention, was designed specifically to fill that gap.
The distinction matters given the alternatives. Newer diabetes-prevention drugs such as GLP-1 receptor agonists, including semaglutide and liraglutide, have shown genuine promise in preventing or delaying diabetes in high-risk individuals. But their price tag puts them far beyond the reach of most people in India.
“GLP-1 receptor agonists might eventually support diabetes prevention in LMICs,” the authors acknowledged, adding, “however, their use in India is limited due to their high cost, the need for long-term treatment, and the difficulty of delivering them through existing health systems.”
Peer-led lifestyle change, in other words, is not a consolation prize. For most of the world, it is the only viable option at scale. “For now, lifestyle changes and population-based interventions will remain the primary approach to diabetes prevention in India,” the authors concluded.
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The study does not sidestep what didn’t go as expected. Blood sugar levels, body weight, and blood pressure rose over time in both groups. The gains from the intervention were real but modest. Nearly one in three participants still developed diabetes over the nine years, underscoring just how formidable the challenge remains.
There were structural limitations, too. A long gap between the two-year and nine-year assessments left some questions unanswered. The COVID-19 pandemic, which swept through Kerala during the follow-up period, likely disrupted participants’ ability to maintain lifestyle changes and may have diluted the intervention’s effects.
Certain diagnostic tests, including the oral glucose tolerance test, were not administered at the final follow-up, which could have led to a slight underestimation of diabetes cases.
The authors admitted the constraints. “The COVID-19 pandemic, which had a widespread effect on health behaviours, including in Kerala, likely also affected the ability of participants to sustain lifestyle modifications during the follow-up period and might have attenuated the observed effects of the intervention,” they wrote.
And yet, what holds up under scrutiny is the consistency. The intervention’s benefits were observed broadly across age groups, across men and women, and across different baseline risk categories.
“The consistency of effects based on incidence of diabetes across subgroups supports the broad preventive potential of community-based, peer-led lifestyle interventions,” the authors said.
The researchers are calling for a 15-year follow-up to examine whether the programme’s effects extend to the complications that make diabetes so devastating: kidney damage, nerve disease, and cardiovascular events. The evidence, they argued, is what policymakers will need to commit to embedding peer-support programmes into routine primary care at scale.
“Integrating peer-supported lifestyle modification into routine primary care and community health systems might be a feasible and effective strategy for diabetes prevention in resource-constrained settings,” the authors wrote.
India is grappling with a diabetes burden that has grown faster than almost anywhere else in the world, driven by urbanisation, dietary shifts, and ageing populations. The solutions most often debated in policy circles tend to be expensive, high-tech, and designed for health systems that are inaccessible to most Indians.
The K-DPP points to something different. One monthly session. Two peer leaders per neighbourhood. Nine years of follow-up. A 28% reduction in risk, sustained through a pandemic.
It is not a cure. But it is something that India, and much of the developing world, can build, scale, and afford.
(Edited by Majnu Babu).
