Context: The Invested in Diabetes comparative effectiveness study was investigating two approaches to delivering shared medical appointments (SMAs) when COVID-19 pandemic emerged in March 2020. Given that patients with diabetes are at high risk for negative outcomes during COVID-19, primary care practices had to immediately interrupt delivery of these group visits. Some of these practices were able to adapt to the delivery of virtual SMAs (vSMAs) while some were not. It is not known what characteristics of primary care practices allow practices to pivot to vSMA delivery and whether practices could maintain fidelity to the diabetes education curriculum via vSMAs. Objective: To describe the facilitators for practice adoption of vSMAs and identify specific primary care practices adaptations for delivery of virtual SMAs, and the impact on fidelity of the delivery of the of the evidenced based diabetes self-management curriculum. Study Design and Analysis: Descriptive, qualitative study. Analysis of practice facilitators’ field notes and vSMA observation notes and fidelity scoring were collected between March 2020 and August 2020. Setting: 21 primary care practices in Colorado and Kansas. Population: The primary care practices included 12 federally qualified health clinics (FQHCs), and 11 private practices. Outcome Measures: Adaptations to vSMAs described in practice facilitation field notes were examined and categorized. Observation notes will be analyzed to determine the level of fidelity to the curriculum was delivered during vSMAs. Results: Field notes were examined for differences based on primary care clinic characteristics (e.g., size, region, population served, experience with SMAs and/or diabetes, experience with technology). Preliminary examination of field notes revealed that practices who had existing technological capacity, e.g., EHR with video conferencing and a patient portal, and staff available to conduct diabetes vSMAs were more likely to transition to vSMAs. Additionally, fidelity to the diabetes education curriculum will be reported for vSMAs. Expected Outcomes: Specific practice characteristics impact the adoption of vSMAs. Practices also engaged in several adaptations to the diabetes education curriculum to enhance vSMA delivery, quickly learning ways to enhance use of the virtual telehealth platform to enhance patient experience. Fidelity to the diabetes education curriculum can be assessed during vSMAs via virtual observations.