Comparative Effectiveness of Family DSMES and Standard DSMES Among Diverse Populations

A Siemens analyzer will be utilized to calculate HbA1c (%) for each participant at every time point (except for 18 months post-intervention, which will be collected through medical record abstractions). Changes in the primary outcome measure will be assessed from baseline to each follow-up time point. The primary analytic approach will use general linear models, including mixed effects linear regression models for continuous repeated measures, to model the mean outcome difference and covariance structures between the treatment arms. Analyses will be adjusted for baseline differences in demographic, socioeconomic, and clinical variables, all within repeated mixed linear regression models. Clustering effects within the intervention delivery groups (i.e., within the DSMES classes) will be accounted for in the model as a random effect. We will adjust for potential clinic variations as a dummy coded variable in our model.

BMI will be collected by measuring participant height (without shoes) using a stadiometer, and measuring participant weight (without shoes) using a calibrated digital scale. Weight and height will be used to compute a continuous measure of BMI. BMI at 18 months post-intervention will be abstracted from participant medical records. The analytic approach for secondary outcomes will be similar to those used for the primary outcome.

Waist circumference will be collected by measuring participant's waist using a flexible tape measure. Waist circumference at 18 months post-intervention will be abstracted from participant medical records.The analytic approach for secondary outcomes will be similar to those used for the primary outcome.

Blood pressure will be measured with a sphygmomanometer and stethoscope or digital blood pressure device with the participant seated and arm elevated. Blood pressure at 18 months post-intervention will be abstracted from participant medical records.The analytic approach for secondary outcomes will be similar to those used for the primary outcome.

Through finger prick blood collection, point of care tests will be used used to test lipids using a commercial lipid panel kit and Cholestech LDX analyzer. Total cholesterol at 18 months post-intervention will be abstracted from participant medical records. The analytic approach for secondary outcomes will be similar to those used for the primary outcome.

Through finger prick blood collection, point of care tests will be used used to test HDL using a commercial lipid panel kit and Cholestech LDX analyzer. HDL at 18 months post-intervention will be abstracted from participant medical records. The analytic approach for secondary outcomes will be similar to those used for the primary outcome.

Through finger prick blood collection, point of care tests will be used used to test HDL using a commercial lipid panel kit and Cholestech LDX analyzer. LDL Blood pressure at 18 months post-intervention will be abstracted from participant medical records. The analytic approach for secondary outcomes will be similar to those used for the primary outcome.

Through finger prick blood collection, point of care tests will be used used to test triglycerides using a commercial lipid panel kit and Cholestech LDX analyzer. Triglycerides at 18 months post-intervention will be abstracted from participant medical records. The analytic approach for secondary outcomes will be similar to those used for the primary outcome.

Through finger prick blood collection, point of care tests will be used used to test random blood glucose (not fasting). Blood glucose at 18 months post-intervention will be abstracted from participant medical records. The analytic approach for secondary outcomes will be similar to those used for the primary outcome.

The Summary of Diabetes Self-Care Activities (SDSCA) will be used to measure engagement in self-management activities. The SDSCA consists of 12 items to assess the self-reported frequency of performing diabetes self-care tasks, including testing blood sugar, following healthful eating plans, and exercising regularly. The SDSCA will be administered to participants at baseline, immediate post-intervention, 6 months post-intervention, and 12 months post-intervention. The analytic approach for secondary outcomes will be similar to those used for the primary outcome.

The Diabetes Management Self-Efficacy Scale (DMSES) will be used to measure patient's confidence in managing their diabetes. The DMSES consists of 20 items to assess self-reported confidence in managing aspects of their diabetes. The DMSES will be administered to participants at baseline, immediate post-intervention, 6 months post-intervention, and 12 months post-intervention. The analytic approach for secondary outcomes will be similar to those used for the primary outcome.

The Adherence to Refills and Medications Scale for Diabetes Medicines (ARMS-D) will be used to measure patient's adherence to their medications (if prescribed). The ARMS-D consists of 11 items to assess self-reported adherence to diabetes medications. The ARMS-D will be administered to participants at baseline, immediate post-intervention, 6 months post-intervention, and 12 months post-intervention. The analytic approach for secondary outcomes will be similar to those used for the primary outcome.

The Problem Areas in Diabetes Scale (PAID)-5 will be used to measure diabetes distress. The PAID-5 consists of 5 items to assess self-reported diabetes-related emotional distress, including feeling scared or depressed. The PAID-5 will be administered to participants at baseline, immediate post-intervention, 6 months post-intervention, and 12 months post-intervention. The analytic approach for secondary outcomes will be similar to those used for the primary outcome.

The DAWN2 Impact of Diabetes Profile (DIDP) will be used to measure the perceived impact of diabetes on patients' quality of life. The DIDP consists of 6 items to assess self-reported impacts on quality of life, including physical health, financial situation, and relationships with others. The DIDP will be administered to participants at baseline, immediate post-intervention, 6 months post-intervention, and 12 months post-intervention. The analytic approach for secondary outcomes will be similar to those used for the primary outcome.