Impacts of Diabetes Self-Management Education and Support Programs in Hispanic Church Settings: A Cluster-Randomized Trial Comparing Faith-Based and Faith-Placed Approaches

<b>Background/Objectives:</b> This study aimed to adapt evidence-based diabetes self-management education and support (DSMES) into a faith-based (FB) context for Hispanic communities and compare its effectiveness to a faith-placed (FP) approach using the church as a venue for DSMES delivery. <b>Methods:</b> A cluster-randomized trial was conducted among adults with type 2 diabetes from predominantly Hispanic churches. The churches were assigned to either the FB Group (nine churches, n = 146) or the FP Group (seven churches, n = 125). The FB Group, led by trained lay health leaders, received a health sermon, a six-session DSMES program, and a seven-session Healthy Bible Study. The FP Group, led by outside health professionals, received the same six-session DSMES and a seven-session partial attention control curriculum. Key outcomes, including hemoglobin A1c (HbA1c), waist circumference (WC), diabetes distress, self-care activities, and self-efficacy, were assessed at baseline, 6, 9, and 12 months. <b>Results:</b> The FB Group had lower HbA1c levels than the FP Group at 6 months (-0.3%, <i>p</i> < 0.01), with no within-group differences post-intervention. No significant between-group differences were found for other outcomes. Within-group comparisons from baseline showed that both groups reduced WC at 9 and 12 months. Both groups showed reductions in diabetes distress and increased self-efficacy at all time points post-intervention (<i>p</i> < 0.05). The FB Group increased self-care scores at all time points post-intervention, while the FP Group increased at 9 and 12 months. <b>Conclusions:</b> DSMES can be effectively delivered in church settings by trained lay leaders or health professionals in Hispanic communities. Adding a spiritual dimension to DSMES may enhance outcomes.