• Bethany M Kwan, L Miriam Dickinson, Jennifer Dailey-Vail, Russell E Glasgow, R Mark Gritz, Dennis Gurfinkel, Christina M Hester, HoltropJodi SummersJSDepartment of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA.Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA., Patrick Hosokawa, Angela Lanigan, Donald E Nease, Andrea Nederveld, Phoutdavone Phimphasone-Brady, Natalie D Ritchie, Martha Sajatovic, Robyn Wearner, Anowara Begum, Madelaine Carter, Thomas Carrigan, Barbara Clay, David Downey, Ramona Koren, Sharon A Trujillo, and Jeanette A Waxmonsky.
• Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA. bethany.kwan@cuanschutz.edu.
• J Gen Intern Med. 2024 Nov 1; 39 (15): 297029792970-2979.

BackgroundDiabetes self-management education and support can be effectively and efficiently delivered in primary care in the form of shared medical appointments (SMAs). Comparative effectiveness of SMA delivery features such as topic choice, multi-disciplinary care teams, and peer mentor involvement is not known.ObjectiveTo compare effects of standardized and patient-driven models of diabetes SMAs on patient-level diabetes outcomes.DesignPragmatic cluster randomized trial.ParticipantsA total of 1060 adults with type 2 diabetes in 22 primary care practices.InterventionsPractice personnel delivered the 6-session Targeted Training in Illness Management (TTIM) curriculum using either standardized (set content delivered by a health educator) or patient-driven SMAs (patient-selected topic order delivered by health educators, behavioral health providers [BHPs], and peer mentors).Main MeasuresOutcomes included self-reported diabetes distress and diabetes self-care behaviors from baseline and follow-up surveys (assessed at 1st and final SMA session), and HbA1c, BMI, and blood pressure from electronic health records. Analyses used descriptive statistics, linear regression, and linear mixed models.Key ResultsBoth standardized and patient-driven SMAs effectively improved diabetes distress, self-care behaviors, BMI (- 0.29 on average), and HbA1c (- 0.45% (mmol/mol) on average, 8.3 to 7.8%). Controlling for covariates, there was a small, significant effect of condition on overall diabetes distress in favor of standardized SMAs (F(1,841) = 4.3, p = .04), attributable to significant effects of condition on emotion and regimen distress subscales. There was a small, significant effect of condition on diastolic blood pressure in favor of standardized SMAs (F(1,5199) = 4.50, p = .03). There were no other differences between conditions.ConclusionsBoth SMA models using the TTIM curriculum yielded significant improvement in diabetes distress, self-care, and HbA1c. Patient-driven diabetes SMAs involving BHPs and peer mentors and topic selection did not lead to better clinical or patient-reported outcomes than standardized diabetes SMAs facilitated by a health educator following a set topic order.Nih Trial Registry NumberNCT03590041.© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.

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