Project Summary

This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final.

What is the research about?

Nearly 1 in 10 Americans have diabetes. Compared with people who don’t have diabetes, people with diabetes are more likely to have other serious health problems. These problems include heart disease, stroke, kidney failure, and vision loss. They may also be at risk for early death. Exercising, eating healthy, and taking medicines as directed can help patients manage their diabetes. Group medical visits are an effective way to educate patients and help them manage their diabetes. First, patients have a short one-on-one visit with a primary care provider. Then they have a longer group session with other people with diabetes to learn about living with diabetes.

This study is comparing a uniform approach to group medical visits to an approach that allows patients to choose topics covered in the visits. The research team is examining how each approach affects the health and well-being of people with diabetes.

Who can this research help?

Clinic directors and staff can use the findings from this study when considering what type of group visits to offer patients. Patients with diabetes and their healthcare providers can use findings to understand the options for group medical visits and decide if they want to take part.

What is the research team doing?

The research team is working with 20 primary care and community mental health centers in Colorado. Each site is enrolling 72 patients with diabetes into group visits. Patients attend a six-session group visit program called Targeted Training for Illness Management, or TTIM. Each session covers topics such as exercise, healthy eating, taking medicine, coping with diabetes, and social support. Half of the clinics provide uniform group visits. The other half follow a patient-driven approach. All patients within a practice receive the same type of group visit.

In the patient-driven approach, patients choose the time spent on each topic. They also choose the order of the topics. A diabetes peer educator co-leads the sessions with a team that includes a health educator, a medical provider, and a mental health provider. In groups using the uniform version of TTIM, patients receive sessions on preset topics in a fixed order. A health educator leads the sessions alone.

Before the program starts and after it ends, the research team is using a survey to measure the stress and anxiety patients feel because of their diabetes. The team is also tracking patients’ ability to manage their diabetes, blood sugar, blood pressure, and weight. They are also looking at how engaged patients are in their care. Using another survey, the team is asking staff members at each clinic how the group visits work as part of regular care for people with diabetes.

Patients, caregivers, researchers, and representatives from healthcare practices and health plans are working with the research team to design the study, examine findings, and share results.

Research methods at a glance

Design Elements Description
Design Cluster-randomized pragmatic trial
Population 1,440 adults 18 years of age or older with type 2 diabetes receiving care at a participating clinic who are not pregnant or planning on becoming pregnant in the next year, terminally ill, or planning on moving in the next year
  • Targeted Training for Illness Management (TTIM) curriculum led by a health educator and delivered in a uniform order
  • TTIM curriculum co-led by a health educator and diabetes peer mentor; patients choose the time spent on topics and the order of sessions; may include sessions led by a team that includes a medical provider or behavioral health provider

Primary: diabetes distress

Secondary: autonomy support, diabetes self-management behaviors, hemoglobin A1c, blood pressure, body mass index, patient engagement, and practice-level value and sustainability

Timeframe 9-month follow-up for primary outcome

Project Information

Bethany Matthews Kwan, PhD, MSPH
Jeanette Waxmonsky, PhD
University of Colorado Denver
Comparing Patient-Centered Outcomes of Standardized vs Patient-Driven Diabetes Shared Medical Appointments

Key Dates

August 2017
January 2024

Study Registration Information


Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: September 26, 2023