Title : Baseline characteristics, care gaps, and barriers among adults with diabetes enrolled in a community-led program in rural Belize

Introduction: Sarteneja is a rural coastal community in northern Belize with historically limited access to consistent medical care. Until recently, the village lacked a permanent physician, and residents relied on intermittent outreach clinics or travel to access services. Although infrastructure improvements have reduced travel times, accessing routine care still requires early-morning travel to the nearest clinic, often involving a full-day commitment and transportation costs. For older adults with limited mobility, travel frequently requires accompaniment, increasing logistical and financial burdens. A community-led diabetes support program utilizing lay community health workers (CHWs) was established to provide ongoing education and monitoring within the village. As part of enrollment, we characterized baseline clinical status and care gaps among participating adults to guide targeted CHW support strategies.

Objective: To characterize baseline clinical status, behavioral patterns, and self-efficacy among adults with diabetes enrolling in a community-led CHW initiative to inform targeted education and support.

Methods: We conducted a community-based descriptive analysis of adults with type 2 diabetes enrolling in a layperson CHW support program in Sarteneja, Belize. At enrollment, participants underwent anthropometric assessment, blood pressure measurement, point-of-care glucose testing, and HbA1c evaluation. A structured survey assessed demographics, medication use, healthcare access, self-management behaviors, and diabetes-related self-efficacy. Descriptive statistics summarized baseline clinical burden and care gaps.

Results: Sixty-four adults enrolled. Mean age was 59.0 years (SD 13.2), and 75% were female. Mean HbA1c was 8.1% (SD 2.1), with 31.3% demonstrating HbA1c ≥9%. Forty-five percent met criteria for hypertension (≥140/90 mmHg), and mean BMI was 31.8 kg/m² (SD 7.3), with 85.9% classified as overweight or obese.

Participants reported high medication adherence (mean 6.3 days/week; 79.7% reporting daily use); however, 27.5% of daily users remained poorly controlled (HbA1c ≥9%). Behavioral and knowledge gaps were evident: 26.6% reported forgetting medications, 28.1% reported no weekly exercise, and 38.1% did not report regular home glucose monitoring. Notably, 93.8% were unable to identify their A1c goal. Over half (54.7%) reported managing diabetes without support from family or peers. Mean self-reported confidence in managing diabetes was 5.6/10, and 37.5% reported low confidence in responding to high or low blood glucose levels.

Conclusion: Adults enrolling in this community-based diabetes support program demonstrated substantial cardiometabolic burden alongside behavioral, educational, and self-efficacy gaps despite widespread medication use. These findings identify modifiable targets for tailored CHW-led education and support within the existing initiative. Community-based models emphasizing sustained engagement and patient empowerment may strengthen chronic disease self-management in rural settings.

Dylan is a Bachelor of Science in Public Health student at the University of South Carolina, expected to graduate in December 2026. His research has included involvement in the REMEDY study, which examines how diet, physical activity, and sleep are associated with gut microbiome health and colorectal cancer risk. He previously presented at Discover USC on the accuracy of wearable devices in classifying movement in children.