Shared Medical Appointments for Type 2 Diabetes

Recruiting at 1 trial location

Overseen By Fatima Aguilar

Age: < 65

Sex: Any

Trial Phase: Academic

Sponsor: Children's Hospital Los Angeles

Disqualifiers: Non-verbal, others

Compensation: Varies

Number of Visits: 4

74 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether shared medical appointments effectively treat young people with type 2 diabetes. Participants will engage in group activities focusing on nutrition, exercise, peer support, and stress management, alongside their usual care. The goal is to determine if these shared appointments improve diabetes care compared to standard individual appointments. The trial seeks teens with type 2 diabetes who are willing to attend all meetings and can speak English. As an unphased trial, it offers a unique opportunity for participants to contribute to innovative diabetes care approaches and potentially benefit from enhanced support and management strategies.

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

What prior data suggests that shared medical appointments are safe for youth with type 2 diabetes?

Research has shown that shared medical appointments (SMAs) are generally well-received by people with type 2 diabetes. One study found no difference in health outcomes or healthcare usage between SMAs and regular care, indicating their safety for patients. Another study reported that 22 practices successfully reached many patients with diabetes over three years, with regular attendance at these appointments. This regular attendance suggests that patients find SMAs acceptable and manageable.

Overall, SMAs appear to be a safe and practical way to provide care for people with diabetes. They include group activities like nutrition advice and stress management, which are usually low-risk. While individual experiences may vary, evidence suggests SMAs are a safe choice for many. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Shared Medical Appointments for managing Type 2 Diabetes because they offer a unique approach by combining medical care with peer support. Unlike standard treatments that involve individual consultations with healthcare providers, these appointments bring together a group of patients with similar conditions. This setting encourages shared learning and experiences, potentially improving motivation and adherence to treatment plans. The collaborative environment might lead to better blood sugar control and overall health outcomes by fostering a sense of community and accountability among participants.

What evidence suggests that shared medical appointments are effective for type 2 diabetes?

Research has shown that shared medical appointments (SMAs), which participants in this trial may receive, can benefit people with type 2 diabetes. One study found that patients who attended SMAs reduced their A1c levels, a measure of blood sugar, from 8.89% to 8.15% in six months and maintained these improvements after a year. Another study found that SMAs can boost confidence in managing diabetes, which is crucial for long-term health. Although SMAs are promising, some clinics may find them challenging to set up. Overall, SMAs could enhance diabetes management by providing support and education in a group setting. ^{2 4 6 7 8}

Who Is on the Research Team?

Lily C Chao

Principal Investigator

Children's Hospital Los Angeles

Are You a Good Fit for This Trial?

This trial is for young people with type 2 diabetes and hypertension. Participants will need to attend quarterly clinic appointments, engage in group activities, and complete surveys. Specific eligibility details are not provided.

Inclusion Criteria

Receives type 2 diabetes care at either CHLA or UCSF

Exclusion Criteria

Unwillingness to wear blinded CGM devices (2 weeks at baseline and at the conclusion of the study)

I am unwilling to complete the study surveys.

I cannot speak or join in group activities.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Implementation

Design and implement four group activities centered around nutrition therapy, peer interactions, exercise, and stress management. Design the clinical workflow for the Team Clinic.

5 months

Quarterly clinic appointments and group activities

Monitoring

Participants' glycemic control and other health metrics are monitored using various questionnaires and surveys.

1 year

4 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after the main intervention phase.

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Shared Medical Appointments

Trial Overview The study is testing if shared medical appointments can be a good way to provide care compared to the usual one-on-one visits (standard of care). It looks at whether this approach is acceptable and improves psychosocial outcomes.

How Is the Trial Designed?

Group I: Shared Medical Appointment Active Control 1 Intervention

Group II: Standard Care Placebo Group 1 Intervention

Who Is Running the Clinical Trial?

Children's Hospital Los Angeles

Lead Sponsor

Trials

257

Recruited

5,075,000+

University of California, San Francisco

Collaborator

Trials

2,636

Recruited

19,080,000+

Published Research Related to This Trial

Shared medical appointments (SMAs) may improve glycemic outcomes and diabetes knowledge in patients with type 2 diabetes mellitus (T2DM), based on a review of 19 studies.

However, the effectiveness of SMAs compared to standard care is still unclear due to limited studies and variability in study designs, indicating a need for larger, more standardized research to evaluate their practicality in clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Shared Medical Appointments May Be Effective for Improving Clinical and Behavioral Outcomes in Type 2 Diabetes: A Narrative Review. Menon, K., Mousa, A., de Courten, MP., et al.[2019]

Shared medical appointments can improve education and outcomes for patients with chronic conditions, particularly among the elderly, as shown in several trials.

The effectiveness of shared medical appointments compared to traditional care remains uncertain, as it is unclear if benefits arise from the unique format or simply from increased provider interaction and time spent with patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The use of shared medical appointments in the care of the elderly. Cherniack, EP.[2013]

Diabetes shared medical appointments (SMAs) significantly improved A1c levels in participants compared to usual care, with reductions of up to 0.53% for those attending at least half of the SMAs, based on a study involving 1537 adults with type 2 diabetes.

While SMAs showed immediate benefits in glycemic control, these improvements were not sustained at the 12-month follow-up, indicating a need for further research on long-term strategies to maintain these gains.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluating the Effectiveness of Diabetes Shared Medical Appointments (SMAs) as Implemented in Five Veterans Affairs Health Systems: a Multi-site Cluster Randomized Pragmatic Trial. Heisler, M., Burgess, J., Cass, J., et al.[2022]

A systematic review of nine randomized trials involving various chronic illnesses (excluding diabetes and mental health) found that shared medical appointments do not negatively impact patient quality of life, knowledge, or satisfaction compared to usual care.

Patients attending shared medical appointments experienced fewer hospital admissions, suggesting potential benefits for healthcare systems, although more rigorous studies with larger sample sizes are needed to confirm these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Shared medical appointments for patients with a nondiabetic physical chronic illness: A systematic review. Kelly, F., Liska, C., Morash, R., et al.[2019]

Shared medical appointments (SMAs) significantly improved key health indicators for diabetes patients, including a reduction in hemoglobin A1c levels by an average of 0.55 percentage points and systolic blood pressure by 5.2 mmHg, based on a review of 17 studies.

Despite these improvements in biophysical outcomes, the effectiveness of SMAs on LDL cholesterol levels was not significant, and there was not enough data to assess their impact on patient experience or healthcare costs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Shared medical appointments for patients with diabetes mellitus: a systematic review. Edelman, D., Gierisch, JM., McDuffie, JR., et al.[2022]

Patients involved in shared medical appointments showed notable enhancements in their blood sugar levels, indicating improved glycemic control.

This approach suggests that collaborative care models may be effective in managing diabetes and improving patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Shared Medical Appointments and Their Effects on Achieving Diabetes Mellitus Goals in a Veteran Population. Tardi, A., Kapadia, S., Kurpius, M., et al.[2020]

Shared medical appointments (SMA) for 30 male veterans with diabetes led to significant improvements in key health metrics, including A1c, blood pressure, and cholesterol levels over a 6-month period, with no hospitalizations reported.

Veteran satisfaction with the SMA approach increased significantly, highlighting its potential as an effective intervention for managing chronic conditions like diabetes in the veteran population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementation and Evaluation of Shared Medical Appointments in Veterans With Diabetes: A Quality Improvement Study. Omogbai, T., Milner, KA.[2019]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8175536/

Evaluating the Effectiveness of Diabetes Shared Medical ... 05 level. The 59 P2P participants improved in A1c from a mean of 8.89% to 8.15% at 6 months and 8.25% at 12 months. All sensitivity analyses ...

2. diabetesjournals.org diabetesjournals.org/clinical/article/41/4/526/153574/A-Multi-Method-Study-of-Patient-Reach-and

A Multi-Method Study of Patient Reach and Attendance in a ... Through this study, 22 practices reached 6.2% of patients with diabetes through SMAs over 3 years, with good attendance for both practice types ...

3. clinicaltrials.gov clinicaltrials.gov/study/NCT03590041

Comparative Effectiveness of Diabetes Shared Medical ... In this study, the investigators will compare the effectiveness of patient-driven diabetes Shared Medical Appointments (SMAs) to standardized diabetes SMAs.

4. frontiersin.org frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2017.00263/full

Shared Medical Appointments May Be Effective for ... Shared Medical Appointments May Be Effective for Improving Clinical and Behavioral Outcomes in Type 2 Diabetes: A Narrative Review.

5. bmcprimcare.biomedcentral.com bmcprimcare.biomedcentral.com/articles/10.1186/s12875-023-02006-8

Delivering diabetes shared medical appointments in primary ... Shared medical appointments (SMAs) can increase self-efficacy for self management but are difficult for some primary care practices to implement.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10921542/

Effectiveness of shared medical appointments delivered in ... There was a little difference in the effectiveness of SMAs compared with usual care in terms of health outcomes or healthcare service use in the short-term.

7. diabetes.jmir.org diabetes.jmir.org/2025/1/e57526

Diabetes Medical Group Visits and Type 2 Diabetes Outcomes Methods: We conducted a mediation and moderation analysis of data from the Women in Control 2.0 comparative effectiveness study, which showed ...

8. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC2464960/

Shared medical appointments based on the chronic care model Shared medical appointments for diabetes constitute a practical system redesign that may help to improve quality of care. This approach has accommodated even ...