Comparative Effectiveness of Patient-Driven Versus Standardized Diabetes Shared Medical Appointments: A Pragmatic Cluster Randomized Trial.

Diabetes 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. To compare effects of standardized and patient-driven models of diabetes SMAs on patient-level diabetes outcomes. Pragmatic cluster randomized trial. A total of 1060 adults with type 2 diabetes in 22 primary care practices. Practice 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). Outcomes 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. Both standardized and patient-driven SMAs effectively improved diabetes distress, self-care behaviors, BMI (− 0.29 on average), and HbA1c (− 0.45