This is a four-year pragmatic, cluster randomized comparative effectiveness trial of diabetes shared medical appointments (SMAs) using patient-driven educational content delivered by multidisciplinary care teams including peer mentors, compared to SMAs with standardized content delivered by health educators. The aims are to implement patient-driven and standardized SMAs in twenty practices using stakeholder engagement and evidence-based implementation strategies, and to evaluate differences in patient participation in care, patient-reported outcomes (diabetes distress, self-care behaviors, quality of life), clinical outcomes, and practice-level adoption, implementation, and maintenance.