Background
Diabetes prevalence in adults in the Pacific Islands Region is among the highest in the world (WHO, 2010), and Fiji is no exception.
The increasing incidence of complications due to diabetes is clear evidence that there is a need for alternate measures to combat this avalanche. It also is imminently necessary for diabetics to take ownership of their ailments and be actively involved in managing their diabetes.
Diabetes Fiji Inc and World Diabetes Foundation initiated a four- year project by with capacity building of health care provider and establishing Diabetes community peer group in identified communities with high prevalence of diabetes.
Aim
Empowering people living with Diabetics to take ownership of their health through the creation of Diabetes Community Peer Groups (DCPG). World-wide experiences with DCPGs have shown them to be an effective and successful tool in managing diabetes and its complications.  It develops a sense of camaraderie and enhances sharing of knowledge amongst the peers.
METHOD:
The target was to establish eight community peer groups in the three divisions; by the end of the third year we have successfully established thirty-one groups. From consultation with the Sub Divisional Medicals Officer, Sub Divisional Health Sisters and zone nurses, Diabetes Community Peer Groups were established in communities with:
•	high number people living with diabetes who neglect to attend regular clinics
•	communities with high number of people living with diabetes and with co morbidities
•	those considered high risk as identified through screening.
After a community is identified the Program coordinator accompanied by zone nurses conduct consultation with villages headsman, village heath worker and people living with Diabetes on the program and the Terms of reference (TOR) that outlines the scope of work. If the parties agreed on the TOR, a leader is elected by the group who will be responsible for the functions and safekeeping of consumables. The Program coordinator then gathers baseline data of each member. 
Based on the finding the activities for the year are ascertained. In most cases, complication assessment has not beendone.These are then carried out prior to the peer leaders training. In this training leaders are trained on their roles, and functions of the group, reporting, and engaging member in activities that enhance their lifestyles.
Discussion:
The groups were assisted with diabetes screening equipment, sphygnomometer and weight scale for regular assessment during their weekly meetings. Results are then recorded by the group leaders. Members were able to discuss issues and challenges pertaining to their health. Through peer sharing most have been empowered and motivated to make positive changes. The medical team visits the peer groups according to the schedules developed.

Results:
The peer groups successfully conducted an open day during a SOPD clinic day and demonstrated skills acquired during peer meeting such as cooking demonstration, simple exercises, demonstration of foot wash and members shared their personal testimonies. The biggest impact non peer members living with diabetes is seeing peer groups conducts awareness and demonstration instead of health professional and their motivational testimonies. 
The program has also strengthened family support as members visited domiciliary cases and conduct awareness in their respective communities. Also the groups established their own backyard garden. A member with above knee amputation to both limbs challenged others with his vegetable garden. Members have seen significant improvement in kidney functions (Egfr), HbA1c and lipid profile. Clinic nurses have also noted a reduction in defaulter’s members in turn to look out for each other and encourage one and other to attend regular clinic.
Drawback:
•	unavailability of transport, medical professional and reagent for testing from the Ministry of Health
•	turnover of Peer group members
•	laxity in few of the group leaders and members 


Way forward:
The Diabetes Peer Group program is one of the initiatives that can be used to empower people living with diabetes to improvement their health status, prevent complication and assist the health department in community outreaches. They are also powerful advocates of healthy living.

Diabetes community peer group project initiative in Fiji