Implementing virtual diabetes self-management education in two health systems (VIDA): a mixed-methods pilot study

Group-based diabetes self-management education (DSME) has long been shown to improve health outcomes, but how to effectively adapt these programs to virtual settings in diverse healthcare systems remains unclear. Utilizing the RE-AIM implementation framework, this mixed-methods pilot study evaluated the feasibility, benefits, and challenges of implementing virtual group DSME for adults with Type 2 diabetes mellitus in two distinct systems: a federally qualified health center and a private, not-for-profit health system.

Adults with elevated glycosylated hemoglobin (A1c) levels and at least one cardiovascular comorbidity were invited to participate in six monthly 60- to 90-minute online group education sessions led by diabetes educators. Sessions focused on disease and lifestyle education, peer support, and structured goal setting. Quantitative data captured patient recruitment, attendance, and engagement metrics. Semi-structured interviews with patients, providers, and staff explored perceived benefits, barriers, and implementation experiences.

Of 97 eligible patients, 50 were reached and 11 enrolled, with 10 completing at least one session. Participants had an average age of 63.5 years old, were 90% African American and 80% female, and had an average A1c of 8.7% (SD 0.7). The average attendance rate was 3.6 (SD 1.9) sessions. The most frequent reasons for declining enrollment in the study were competing responsibilities and stating they did not need additional diabetes education, while accessing technology was rarely a limiting factor. Participants reported high satisfaction with the program, emphasizing the value of shared experiences, increased accountability, improved disease knowledge, and convenience of attending virtually from home. Providers and staff viewed the sessions as a valuable adjunct to clinical care that reinforced behavioral goals beyond the limits of brief primary care visits. Reported challenges included scheduling conflicts with patients and mistrust in medical advice. The intervention demonstrated strong fidelity to implementing the treatment design and curriculum, with most patients successfully formulating goals related to exercise and blood glucose monitoring.

This study provides initial evidence that virtual group DSME can be feasible, well-received, and adaptable across different healthcare environments. It provides initial evidence in understanding how technology-enabled group models can deliver chronic disease education in different health system contexts while empowering self-management in diverse urban populations.