Michigan Diabetes Project: A Self-Management Intervention to Improve Type 2 Diabetes Outcomes in Adults.

Adults with elevated clinical risk factors experience nearly double the prevalence of type 2 diabetes (T2D) and increased mortality from related complications compared to the general population. Once diagnosed, these individuals often demonstrate suboptimal glycemic management, leading to heightened risk of adverse outcomes. Our previous work indicates that behavioral norms and self-reliance expectations may limit care-seeking behaviors and reduce adherence to clinical recommendations, thereby compromising diabetes management. This evidence suggests that diabetes self-management support (DSMS) interventions must be adapted to reflect the behavioral profiles, health system engagement patterns, and logistical constraints common among these individuals to be effective. However, many PLDSMS studies have enrolled participants whose clinical profiles and healthcare utilization patterns differ from the populations most affected by suboptimal management, limiting generalizability. To address this gap, our team used two pilot grants to develop and deliver a virtually administered, evidence-based PLDSMS protocol tailored for logistical feasibility and real-world implementation. These pilots, MDP I and MDP II, demonstrated improvements in A1C, dietary behavior, self-monitoring, and reductions in diabetes-related distress. They also showed that PLs can deliver this model with fidelity in virtual settings and that the approach is both usable and well-received, with an average recruitment and retention rate of 80%. The objective of our proposed study is to conduct a two-arm, Hybrid Type 1 effectiveness-implementation trial comparing the adapted PLDSMS with enhanced usual care (EUC) among adults with T2D and elevated clinical risk. Specifically, we will: (1) collaborate with a Clinical, Administrative, and Research Advisory Board (CARAB) to optimize implementation for scalability; (2) evaluate PLDSMS impact on A1C, diabetes-related distress, and T2D self-management behaviors relative to EUC; and (3) conduct a comprehensive evaluation of implementation outcomes including acceptability, feasibility, and cost-effectiveness within the Detroit Health Department (DHD). The PRISM framework and the Design for Dissemination and Sustainability (D4DS) Planner will be used to guide implementation analysis and sustainability planning. This study will: a) validate the effectiveness of an empirically adapted, evidence-based DSMS model in a pragmatic public health setting; b) generate insights on the integration of PLDSMS into existing clinical and public health infrastructures; and c) inform future large-scale dissemination of structured, peer-delivered support models aligned with NIDDK’s goal to advance science-based strategies for T2D management and prevention.