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||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|
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
|9-month follow-up for primary outcome|