Evidence Table

PICOT Question: For nursing staff caring for adult patients with diabetes (P), how does implementing the ADA diabetes follow-up protocol (I), compared to current practices (C), affect glycemic control (O) over 8 weeks (T)?

APA Source Reference
(Include the DOI or URL)

Indicate: Peer Reviewed,
Clinical Guideline, or
Best Practice Guideline

Aim, Hypothesis,
or Research Question

Conceptual or
Theoretical Framework

Research Design/Methodology

Measurement
Method

Sample Population
or Setting

Research Variables

Data Analysis

Findings

Gaps in Research

Critical Appraisal of the Evidence
(Identify tools used, e.g., SORT)

Good Quotes

Additional Notes

Dailah, H. G. (2024). The Influence of Nurse-Led Interventions on Diseases Management in Patients with Diabetes Mellitus: A Narrative Review. Healthcare, 12(3), 352. https://doi.org/10.3390/healthcare12030352

Peer Reviewed

To identify the impact of nurse-led interventions on diabetes management and discuss nursing interventions, roles of nurses as educators and motivators in DM management

Not specified

Narrative Review

Literature review of databases: Cochrane, Google Scholar, PsycINFO, PubMed, Web of Science, Scopus, ScienceDirect, CINAHL (2010-2023)

Review articles, original research, clinical trials, and books containing information on nurse roles in DM management

Nurse-led interventions, diabetes self-management education (DSME), glycemic control, HbA1c levels, patient outcomes

Narrative synthesis of literature

Nurse-led interventions result in significant improvements in diabetes knowledge, psychological outcomes, self-management behaviors, and physiological outcomes. Studies showed significantly reduced HbA1c levels in nurse-led education groups. Nurses spend most time with patients and are better positioned to provide diabetes care than other healthcare professionals.

Need for more dedicated Diabetes Inpatient Specialist Nurses (DISNs) – 22% of hospitals lack DISNs. Ambiguity regarding nurse roles in providing diabetes care, especially in countries without recognized DISN groups.

Level of Evidence: V (Narrative Review)

“Nurses are in a better position to provide care and education to PWD compared to other healthcare professionals since nurses spend most of their time with patients”

Emphasizes need for proper nurse training in diabetes management. Highlights that nurses can independently provide care in collaboration with other healthcare providers.

ElSayed, N. A., Aleppo, G., Aroda, V. R., et al. (2022). Improving care and promoting health in populations: Standards of care in diabetes—2023. Diabetes Care, 46(1), 10–18. https://doi.org/10.2337/dc23-s001

Clinical Guideline

To provide ADA Standards of Care in Diabetes including clinical practice recommendations, treatment goals, and tools to evaluate quality of care

Chronic Care Model (CCM)

Clinical Practice Guidelines

Evidence-based guidelines with grading system (A, B, C levels)

General diabetes population – adults with diagnosed diabetes

A1C levels, blood pressure, LDL cholesterol, patient-centered care, social determinants of health (SDOH), care delivery systems

Expert consensus and evidence synthesis

In 2013-2016, 64% of adults met individualized A1C targets, 70% achieved blood pressure targets, 57% met LDL targets, but only 23% met all three plus nonsmoking. Mean A1C increased from 7.3% (2005-2008) to 7.5% (2013-2016). Chronic Care Model implementation reduced cardiovascular disease risk by 56.6%, microvascular complications by 11.9%, and mortality by 66.1%.

Persistent variability in quality of diabetes care across professionals and practice settings indicates need for system-level improvements. Young adults, women, and non-Hispanic Black individuals less likely to meet treatment targets.

Level of Evidence: I (Clinical Practice Guidelines from ADA)

“Care systems should facilitate team-based care, including those knowledgeable and experienced in diabetes management as part of the team” (Recommendation 1.3, Level B)

Emphasizes importance of multidisciplinary team approach, telehealth integration, and addressing SDOH. Economic cost of diabetes: $327 billion annually in U.S. (2017).

Ezeamii, V. (2024). Revolutionizing healthcare: How Telemedicine Is Improving Patient Outcomes and Expanding Access to Care. Cureus, 16(7), e63881. https://doi.org/10.7759/cureus.63881

Peer Reviewed

To investigate telemedicine’s effects on patient outcomes, access to care, and its role in evolving healthcare landscape

Not specified

Systematic Review

MeSH terms and keywords through electronic databases; both quantitative and qualitative empirical studies

Various patient populations utilizing telemedicine services, particularly diabetes patients

Patient outcomes, access to care, HbA1c levels, patient engagement, cost savings, geographical barriers

Narrative synthesis categorized into themes: patient outcomes and access to care

Telemedicine significantly improves patient outcomes in chronic disease management, especially diabetes. Telehealth platforms enhance diabetes management by increasing patient engagement and improving HbA1c levels. Services overcome geographical barriers and improve patient access and satisfaction.

Digital literacy, access to technology, and socioeconomic status affect telemedicine effectiveness. Risk of exacerbating existing disparities if vulnerable populations lack technological access.

Level of Evidence: I (Systematic Review)

“Telemedicine significantly improves patient outcomes, access, and satisfaction in chronic disease management, especially diabetes care”

COVID-19 pandemic accelerated telemedicine adoption. Applicable to remote diabetes monitoring and follow-up care protocols.

Fracso, D., Bourrel, G., Jorgensen, C., et al. (2022). The chronic disease Self-Management Programme: A phenomenological study for empowering vulnerable patients with chronic diseases included in the EFFICHRONIC project. Health Expectations, 25(3), 947–958. https://doi.org/10.1111/hex.13430

Peer Reviewed

To understand the effects of the Chronic Disease Self-Management Programme (CDSMP) on lived experience of vulnerable patients based on their needs and expectations

Phenomenological approach

Qualitative phenomenological semio-pragmatic study

37 in-depth interviews with 20 patients (20 before/17 after CDSMP)

20 vulnerable patients with chronic diseases in France (EFFICHRONIC project)

Patient empowerment, identity transformation, relationship with others, bodily experience, motivation, sense of belonging

Phenomenological analysis of interview transcripts

CDSMP transforms existential dimensions (identity, relationships, bodily experience) and generates new needs in vulnerable persons. Program induces motivation and sense of belonging. Participants became actors of their own health achieving empowerment. Program awakened desire to take better care of health and develop personal skills.

Some limitations reported in the program. Need for facilitator training to elicit lived experience of patients. Patient-centered approach requires adapting program design to individual patient singularity.

Level of Evidence: VI (Qualitative Study)

“By resonating with the expectations and needs of participants, the CDSMP induces motivation and a sense of belonging to a community of peers”

Relevant for understanding patient perspectives on diabetes self-management programs. Emphasizes importance of peer support and community in chronic disease management.

Huang, Y., Li, S., Lu, X., Chen, W., & Zhang, Y. (2024). The Effect of Self-Management on Patients with Chronic Diseases: A Systematic Review and Meta-Analysis. Healthcare, 12(21), e2151. https://doi.org/10.3390/healthcare12212151

Peer Reviewed

To explore effects of self-management interventions on quality of life, self-efficacy, depression, and anxiety in patients with chronic diseases

Not specified

Systematic Review and Meta-Analysis

Searched PubMed, EMBASE, Web of Science; calculated standardized mean difference (SMD) and 95% CI

34 studies involving 7,603 patients with chronic diseases

Quality of life (QOL), self-efficacy, depression, anxiety, self-management interventions

Meta-analysis with subgroup analysis; heterogeneity assessment

Self-management interventions significantly improved QOL (95%CI 0.01-0.15, p=0.03), self-efficacy (95%CI 0.19-0.62, p<0.001), and reduced depression (95%CI -0.23 to -0.07, p<0.001). No significant effect on anxiety (95%CI -0.18-0.03, p=0.18). Studies with mean age >60 years and follow-up >6 months more effective for QOL improvement.

Self-management interventions did not show significant improvements in anxiety symptoms. Need more research on optimal intervention duration and age-specific approaches.

Level of Evidence: I (Systematic Review and Meta-Analysis)

“Self-management interventions are more effective than routine care in managing chronic diseases, significantly improving patients’ quality of life, self-efficacy, and reducing depressive symptoms”

Follow-up >6 months optimal for QOL improvement. Interventions help patients adapt to disease changes and prevent progression.

Jiang, L., Yan, J., Yao, J., et al. (2024). Nurse-led follow-up care versus routine health education and follow-up in diabetes patients: An effectiveness analysis. Medicine, 103(22), e38094. https://doi.org/10.1097/md.0000000000038094

Peer Reviewed

To evaluate the effectiveness of nurse-led follow-up care versus routine health education and follow-up for patients with diabetes

Not specified

Retrospective comparative study

Zung Self-Rating Depression and Anxiety Scale; Summary of Diabetes Self-Care Activities

721 patients with type 1 and type 2 diabetes: nurse-led care (n=108), routine care + Tai Chi (n=205), Tai Chi only (n=408)

Knowledge regarding diabetes, anxiety, depression, self-care activities, educational programs, Tai Chi exercises

Comparative analysis at before follow-up care (BFC) and after 6 months of follow-up care (AFC)

Before follow-up: knowledge ≤1.75, anxiety/depression ≥52 each, self-care ≤37. After 6 months nurse-led care: significant improvements in diabetes knowledge, threat perception, anxiety, depression, and self-care activities (P<.001 for all) compared to routine follow-up and Tai Chi only groups.

Study conducted only in Chinese type 1 or 2 diabetes patients. Long-term sustainability beyond 6 months not assessed.

Level of Evidence: IV; Technical Efficacy: Stage 5

“Nurse-led aftercare, including educational programs with Tai Chi exercises for 6 months, decreased anxiety and depression and improved knowledge regarding diabetes and its threat”

6-month follow-up period relevant to 12-week PICOT timeframe. Demonstrates effectiveness of structured nurse-led programs with educational components.

Höld, E., Grüblbauer, J., Wiesholzer, M., et al. (2022). Improving glycemic control in patients with type 2 diabetes mellitus through a peer support instant messaging service intervention (DiabPeerS): Study protocol for a randomized controlled trial. Trials, 23(1), 308. https://doi.org/10.1186/s13063-022-06202-2

Peer Reviewed

To analyze the impact of a peer-supported instant messaging service (IMS) intervention in addition to standard diabetes therapy on glycemic control of type 2 diabetic patients

Peer Support Theory

Randomized Controlled Trial (Study Protocol)

Biochemical, behavioral, and psychosocial parameters measured before, during, after intervention, and after follow-up

205 participants with type 2 diabetes mellitus

HbA1c, cardiovascular disease risk factors, self-efficacy, peer support, instant messaging intervention

Measurements at baseline, middle of intervention, post-intervention (7 months), and follow-up (additional 7 months)

Study protocol shows peer support via IMS is associated with better HbA1c outcomes, improved cardiovascular risk factors, and higher self-efficacy at lower cost compared to standard therapy. IMS provides easy, prompt, inexpensive support.

This is a study protocol; actual results pending. Long-term sustainability of peer support effects needs evaluation.

Level of Evidence: II (RCT Protocol – results pending)

“Peer-supported instant messaging services approaches have significant potential for diabetes management because support can be provided easily and prompt, is inexpensive, and needs less effort”

7-month intervention with 7-month follow-up. Demonstrates innovative approach to maintaining diabetes self-management education effects.

Yunis, B., Pérez, P. E., Jose, J., & Moreno, I. M. (2024). Increasing Self-Efficacy for the Management of Patients with Type 2 Diabetes Through an Advanced Practice Education Program for Primary Care Professionals. Nursing Reports, 14(4), 3830–3846. https://doi.org/10.3390/nursrep14040280

Peer Reviewed

To analyze the impact of an educational program for health professionals on metabolic control of their patients diagnosed with type 2 diabetes

Self-Efficacy Theory

Quasi-experimental longitudinal design with double perspective

Self-efficacy and quality of care evaluated for professionals; biochemical and clinical parameters for patients at baseline and 12 months

157 PC health professionals (77 in intervention); 4,099 patients with type 2 diabetes

Health professional knowledge, self-efficacy, quality of care; patient glucose, HbA1c, eGFR levels

ANOVA for baseline changes; mixed-effect model for variability within staff and between patient groups

Education program significantly improved staff knowledge (p<0.001) and all self-efficacy dimensions (p<0.001). Patients managed by educated professionals showed better glucose (p<0.001), HbA1c (p<0.001), and eGFR (p=0.006) levels after 6 months.

Study conducted in Israel primary care settings; generalizability to other settings unclear. Need for longer follow-up beyond 12 months.

Level of Evidence: III (Quasi-experimental study)

“The advanced practice education program was able to significantly improve their self-efficacy and perceived quality of care, which induced a significant effect on metabolic markers”

8-week education program for professionals; patient outcomes measured at 6 and 12 months. Demonstrates importance of staff education for patient outcomes.

Aldahmashi, H., Maneze, D., Molloy, L., & Salamonson, Y. (2024). Nurses’ adoption of diabetes clinical practice guidelines in primary care and the impacts on patient outcomes and safety: An integrative review. International Journal of Nursing Studies, 154, e104747. https://doi.org/10.1016/j.ijnurstu.2024.104747

Peer Reviewed

To investigate nurses’ adherence to clinical guidelines for diabetes management in primary healthcare and explore factors influencing effective implementation

Effective Practice and Organisation of Care (EPOC) taxonomy

Integrative Review

Comprehensive search of 6 electronic databases (March 2023); studies classified using EPOC taxonomy

10 studies conducted between 2000-2020 examining nurses’ use of T2DM guidelines in primary care

Guideline adherence, HbA1c levels, blood pressure, lipid profiles, patient self-care engagement, nurse roles

Narrative synthesis presented thematically using PRISMA guidelines

Multifaceted educational approach most effective strategy. Guideline adherence consistently improved clinical management, lowering HbA1c, improving BP and lipid profiles, enhancing patient self-care. Nurse-led interventions effective in improving outcomes. Nurses’ roles: education, collaborative practice, program planning/execution, documentation review.

Need to empower nurses with greater autonomy in primary diabetes care. Strategies must be tailored to local needs. Variability in guideline adherence persists.

Level of Evidence: V (Integrative Review); PROSPERO ID CRD42023394311

“Implementing a diverse range of strategies, focusing on comprehensive education for healthcare providers, is paramount for enhancing guideline adherence in diabetes care”

Emphasizes nurse empowerment and education as key to improving patient outcomes. Directly relevant to implementing ADA protocols in nursing practice.

Tiwari, D., & Aw, T. C. (2024). The 2024 American Diabetes Association guidelines on Standards of Medical Care in Diabetes: key takeaways for laboratory. Exploration of Endocrine and Metabolic Diseases, 2024, 158–166. https://doi.org/10.37349/eemd.2024.00013

Clinical Guideline Commentary

To provide focused analysis of 2024 ADA guidelines for laboratory assessment of diabetes

ADA Standards Framework

Clinical Guideline Commentary

Analysis of ADA 2024 guidelines regarding HbA1c testing, diagnostic criteria, POCT requirements

General diabetes population guidelines

HbA1c testing, diagnostic thresholds, point-of-care testing (POCT), fructosamine, glycated albumin, precision medicine

Expert commentary and guideline interpretation

ADA 2024 places HbA1c at forefront of diagnostic hierarchy (≥6.5% threshold). POCT devices must be FDA-approved or NGSP-certified. HbA1c reflects glycemic control over 6-8 weeks. Personalized management approach emphasized with diabetes subtype categorization. Risk-based screening for type 2 diabetes begins at age 35.

HbA1c not suitable for hemoglobin variants, pregnancy, G6PD deficiency – plasma glucose preferred. Need for standardized testing procedures across laboratories.

Level of Evidence: I (Clinical Guideline Analysis)

“The ADA 2024 guidelines affirm the pivotal role of HbA1c for diabetes diagnosis and screening and place HbA1c testing at the forefront of the diagnostic hierarchy”

HbA1c is primary outcome measure for evaluating glycemic control in diabetes follow-up protocols. 6-8 week reflection period aligns with common follow-up intervals.

Asmat, K., Froelicher, E. S., Dhamani, K. A., Gul, R., & Khan, N. (2024). Effect of patient-centered self-management intervention on glycemic control, self-efficacy, and self-care behaviors in South Asian adults with type 2 diabetes mellitus: A multicenter randomized controlled trial. Journal of Diabetes, 16(9), e13611. https://doi.org/10.1111/1753-0407.13611

Peer Reviewed

To test efficacy of patient-centered self-management intervention (PACE-SMI) to improve HbA1c, self-efficacy, and self-care behaviors in adults with T2DM

Patient-Centered Care Theory

Multicenter, parallel two-arm randomized controlled trial

HbA1c, self-efficacy scale, self-care behavior questionnaire; assessed at baseline, post-intervention, 3-month follow-up

612 adults with T2DM and HbA1c ≥7%; Control (n=310), Intervention (n=302); 583 completed 3-month follow-up

HbA1c levels, self-efficacy, self-care behaviors, nurse-led education, individualized counseling, behavioral training

Per-protocol analysis; linear regression for mediation analysis

At 3 months, intervention group had lower HbA1c (8.49% vs 8.74%, mean difference 0.25%, 95%CI -0.01 to 0.51, p=0.03). Self-efficacy improved significantly (mean difference 41.48, p<0.0001). Self-care behaviors improved (mean difference 18.56, p<0.0001). Effect on HbA1c mediated by self-efficacy and self-care improvements (R²=0.232, p<0.001).

Modest HbA1c improvement; larger sample might show greater effects. Study specific to South Asian population; generalizability unclear.

Level of Evidence: II (RCT); Cohen’s d=0.16 for HbA1c (small effect)

“PACE-SMI led to modest but significant improvement in HbA1c and substantial enhancements in self-efficacy and self-care behaviors in adults with T2DM”

8-week intervention with 3-month follow-up (close to 12-week PICOT timeframe). Demonstrates nurse-led, theory-driven, culturally tailored approach effectiveness.

Okemah, J., Neunie, S., Noble, A., & Wysham, C. (2023). Impact on Knowledge, Competence, and Performance of a Faculty-Led Web-Based Educational Activity for Type 2 Diabetes and Obesity: Questionnaire Study Among Health Care Professionals and Analysis of Anonymized Patient Records. Journal of Medical Internet Research Formative Research, 7, e49115. https://doi.org/10.2196/49115

Peer Reviewed

To measure changes in knowledge, competence, self-reported performance and quantitatively evaluate changes using patient data following web-based CME activity

Moore’s Expanded Outcomes Framework (Levels 1-5)

Pre-post intervention study with patient record analysis

Knowledge/competence questionnaires; self-reported performance; anonymized patient record data analysis

50 HCPs before/after activity; 50 patients pre-activity, 50 patients post-activity

HCP knowledge, competence, performance; patient treatment regimens, specialist referrals, incretin-based dual agonists usage

Comparison of means; analysis of treatment patterns and referral patterns

Mean correctly answered questions increased significantly post-activity (4.98 to 5.78, p<0.001). Patient treatment intensified: pre-activity most common was metformin monotherapy (26%) and dual therapy (22%); post-activity shifted to dual therapy (24%) and triple therapy (20%). Referrals to ≥2 specialists increased from 27% to 36%.

Remaining gaps: understanding biology/psychology of obesity, efficacy/safety data for incretin-based dual agonists, role of diabetes educators.

Level of Evidence: IV (Pre-post study)

“This short, web-based CME activity on management of T2D and obesity led to improvements in HCP knowledge, competence, and performance”

Web-based education model applicable to nurse training for ADA protocol implementation. Shows direct link between provider education and patient care intensification.

Murumba, R. G., Naman, R. O., Tuohy, C. A., White, P. A., & Wright, W. (2024). Assessment of adherence to American Diabetes Association guidelines and evaluation of social determinants of health and interventions in patients with type 2 diabetes mellitus in a nurse practitioner–owned clinic. Journal of the American Association of Nurse Practitioners, 37(8), 462–470. https://doi.org/10.1097/jxx.0000000000001084

Peer Reviewed

To assess quality of NP-driven diabetes care based on 2023 ADA Standards of Care and assess/intervene on social determinants of health

ADA Standards of Care Framework

Ongoing quality-improvement project with retrospective chart review

Multiple Plan-Do-Study-Act (PDSA) cycles; retrospective chart review since 2013; SDOH screening

Adult patients with type 2 DM at NP-owned primary care practice

HbA1c levels, adherence to ADA SOC, social determinants of health (SDOH), diabetes metrics, social worker collaboration

Descriptive analysis of A1C trends, SDOH screening frequency, correlation between SDOH and outcomes

Within one year, average A1Cs improved in all patients except those with positive SDOH despite similar care. Recent data showed overall higher A1Cs in patients with positive SDOH screens. Project intervention of social worker collaboration with NPs resulted in improvement in addressing social needs.

SDOH screening not consistently performed or documented. Need for standardized SDOH assessment and intervention protocols.

Level of Evidence: VI (Quality Improvement Project)

“Adherence to ADA SOC for DM management minimizes the risk of diabetes-associated complications”

NP-owned clinic model demonstrates nurse-led care effectiveness. PDSA approach applicable to implementing new protocols. Highlights importance of addressing social barriers to glycemic control.

Abukhalil, A. D., Muhanna, S. A., Madi, M. N., et al. (2024). Adherence to ADA Clinical Guidelines in Type 2 Diabetes Management in Public Health Clinics in Palestine. Patient Preference and Adherence, 18, 2667–2680. https://doi.org/10.2147/ppa.s494951

Peer Reviewed

To evaluate current practices of physicians in Palestine regarding adherence to ADA guidelines for type 2 diabetes management

ADA Clinical Guidelines Framework

Retrospective, cross-sectional, multicenter study

Medical record review; assessment of medication selection, monitoring frequency, screening, glycemic control

362 patients aged ≥18 years with T2DM for ≥1 year at multiple outpatient clinics in Palestine

A1c control, medication adherence to guidelines, GLP1 agonist/SGLT2 inhibitor use, lipid medication, hypertension medication, foot/eye exams

Descriptive statistics; correlation analysis between medication use and glycemic control

53% did not achieve A1c target. Adherence to ADA guidelines for medication selection only 32.22%. Very low GLP1 agonist (0.5%) and SGLT2 inhibitor (7%) prescribing. Biguanides most prescribed (83.1%), sulfonylurea (35.1%), insulin (28.2%). Only 43% on appropriate lipid medications, 66% on appropriate hypertension medications. Foot assessment 27%, eye exams 55%.

Suboptimal adherence to ADA guidelines. Low use of newer evidence-based medications. Inadequate screening for complications. Need for professional education and awareness of current guidelines.

Level of Evidence: IV (Cross-sectional study)

“Adherence to ADA guidelines for diabetes management is suboptimal in selecting appropriate antidiabetic medication based on patient confounding factors”

Demonstrates gap between guidelines and practice. Highlights need for implementation support when adopting ADA protocols. Age, ASCVD, and sulfonylurea use associated with lower glycemic control.

Tiwari, K., Bisht, M., Kant, R., & Handu, S. S. (2022). Prescribing pattern of anti-diabetic drugs and adherence to the American Diabetes Association’s (ADA) 2021 treatment guidelines among patients of type 2 diabetes mellitus: A cross-sectional study. Journal of Family Medicine & Primary Care, 11(10), 6159–6164. https://doi.org/10.4103/jfmpc.jfmpc_458_22

Peer Reviewed

To assess prescribing pattern and adherence to ADA 2021 treatment guidelines in type 2 diabetes patients in tertiary care teaching hospital

ADA 2021 Treatment Guidelines

Cross-sectional study

Prescription pattern analysis; patient demographic details, drugs prescribed with dosage recorded

206 type 2 diabetic patients prescribed anti-diabetic therapy in Uttarakhand, India

Oral anti-diabetic drugs, insulin therapy, fixed-dose combinations (FDC), monotherapy vs combination therapy

Descriptive statistics of prescribing patterns

Oral anti-diabetic drugs prescribed in 149 patients (72.33%). Only 5 patients (3.35%) on metformin monotherapy. Majority on Glimepiride+Metformin FDC (54.36%). MET+DPP4I combination (30.20%). Insulin therapy in 57 patients (27.66%). 185 prescriptions (89.8%) adherent to ADA 2021 guidelines, 21 (10.19%) not adherent.

Shift toward fixed-dose combinations without complete understanding of long-term implications. Small sample size from single center limits generalizability.

Level of Evidence: IV (Cross-sectional study)

“There was a shift in trend towards the use of fixed-dose combinations (FDC) in the management of type 2 DM, and majority of prescriptions were adherent to ADA treatment guidelines”

High adherence rate (89.8%) to ADA guidelines in this setting. Demonstrates feasibility of ADA guideline implementation in diverse settings.

Yimer, Y. S., Addissie, A., Kidane, E. G., et al. (2025). Effectiveness of diabetes self-management education and support interventions on glycemic levels among people living with type 2 diabetes in the WHO African Region: a Systematic Review and meta-analysis. Frontiers in Clinical Diabetes and Healthcare, 6, e1554524. https://doi.org/10.3389/fcdhc.2025.1554524

Peer Reviewed

To evaluate effectiveness of D-SMES interventions compared with usual care in controlling blood glucose among people with T2DM in WHO Africa Region

Diabetes Self-Management Education and Support (D-SMES) Framework

Systematic Review and Meta-Analysis

Searched PubMed, CINAHL, CCRCT, Google Scholar to May 2025; HbA1c and FBS as outcomes; Cochrane RoB2 tool for quality

19 RCT studies, 3,759 participants (1,866 D-SMES, 1,893 usual care) in WHO African Region

HbA1c levels, fasting blood sugar (FBS), diabetes self-management education and support interventions

Random effects model meta-analysis; standardized mean difference (Hedges’ g) with 95% CI

Significant overall effect of D-SMES on HbA1c (SMD=-0.468, 95%CI -0.658 to -0.279, I²=85.5%, p<0.001). Nine of nineteen studies reported significant effects. Prediction interval: true effect size would fall between -1.27 and 0.34 in 95% of comparable populations. 15 studies had low risk of bias.

High heterogeneity (I²=85.5%) suggests variable intervention effectiveness. Cultural and contextual factors may influence outcomes.

Level of Evidence: I (Systematic Review and Meta-Analysis)

“Diabetes self-management education and support interventions are moderately effective in controlling blood glucose levels in T2DM patients”

Moderate effect size supports D-SMES as component of diabetes care protocols. Results generalizable to diverse populations including WHO African Region.

Dineen, T. E., Bean, C., Cranston, K. D., et al. (2021). Fitness Facility Staff Can Be Trained to Deliver a Motivational Interviewing-Informed Diabetes Prevention Program. Frontiers in Public Health, 9, e728612. https://doi.org/10.3389/fpubh.2021.728612

Peer Reviewed

To evaluate effectiveness of Small Steps for Big Changes training for fitness facility staff using 4-level Kirkpatrick training evaluation model

Kirkpatrick 4-Level Training Evaluation Model; Motivational Interviewing

Community case study with training evaluation

Kirkpatrick model: Level 1-satisfaction (5-point scale), Level 2-knowledge/skills, Level 3-behavior observation, Level 4-client outcomes (7-point scales)

8 fitness facility staff trained; 32 clients at risk of developing type 2 diabetes (August 2019-March 2020)

Staff satisfaction, program knowledge, motivational interviewing skills, client-centered delivery, client basic psychological needs support

Mixed methods: quantitative assessment of knowledge/skills/satisfaction; qualitative observation of implementation

Staff satisfied with training (M=4.43, SD=0.45). High post-training scores retained at implementation. Staff used motivational interviewing at client-centered level (M=6.34, SD=0.83). Clients perceived basic psychological needs supported (M=6.55, SD=0.64) and high staff satisfaction (M=6.88, SD=0.33).

Not all staff operated at client-centered level. Need for ongoing coaching and support during implementation. Feasibility in different community settings needs testing.

Level of Evidence: VI (Case study)

“The Small Steps for Big Changes training was successful and fitness facility staff delivered a motivational interviewing-informed program”

Demonstrates non-traditional healthcare workers can be trained in diabetes prevention. Motivational interviewing approach applicable to nursing follow-up protocols.

Graue, M., Igland, J., Haugstvedt, A., et al. (2023). Evaluation of an interprofessional follow-up intervention among people with type 2 diabetes in primary care—A randomized controlled trial with embedded qualitative interviews. Public Library of Science ONE, 18(11), e0291255. https://doi.org/10.1371/journal.pone.0291255

Peer Reviewed

To evaluate effects of empowerment-based interprofessional follow-up intervention on patient-reported outcomes, biomarkers, weight; and explore patient experiences

Empowerment-Based Counselling Model

Randomized Controlled Trial with embedded qualitative interviews

Patient Activation Measure (primary); glycemic control, weight, waist circumference (secondary); qualitative interviews post-trial

Patients with type 2 diabetes in primary care recruited during regular GP visits

Patient activation, glycemic control (HbA1c), weight, waist circumference, empowerment-based counseling, standardized medical report

Between-group and within-group statistical analysis; qualitative thematic analysis of interviews

No difference in primary outcome (Patient Activation Measure). Significant between-group effect for glycemic control (B=-8.6 mmol/l, 95%CI -17.1 to -0.1, p=0.045). Significant within-group changes: weight (B=-1.8kg, 95%CI -3.3 to -0.3, p=0.02), waist circumference (B=-3.9cm, 95%CI -7.3 to -0.6, p=0.02). Qualitative data: intervention opened patients’ eyes for reflections and awareness, but needed time to take action.

12-month intervention may be too short for activation changes. Patients needed longer time to translate awareness into action. Study in primary care setting; may not generalize to all settings.

Level of Evidence: II (RCT with qualitative component)

“The intervention gave rise to other insights and a greater understanding of their health challenges”

12-month intervention aligns with longer follow-up needs. Demonstrates importance of interprofessional collaboration and empowerment approach in diabetes care.

Chen, Y., Zhou, T., Su, L., Guo, Y., & Ke, X. (2025). Effects of nurse-led telephone interventions on HbA1c levels in patients with type 2 diabetes: A Meta-analysis-based evaluation of follow-up protocols. BioMed Central Nursing, 24(1), 1–10. https://doi.org/10.1186/s12912-025-02782-x

Peer Reviewed

To assess effectiveness of nurse-led telephone interventions in controlling HbA1c with subgroup analyses based on frequency, duration, content, and intervals

Not specified

Meta-Analysis

Searched 8 databases until Feb 2024; Cochrane risk of bias criteria; RevMan 5.4 for analysis

13 studies including 2,294 T2DM patients

HbA1c levels, follow-up frequency (12, 16 calls), call duration (10-15, 20-25 min), intervals (weekly, half-month), content (medication, diet, exercise, glucose monitoring)

Meta-analysis with subgroup analyses; publication bias assessed with funnel plot, Egger’s and Begg’s tests

Nurse-led telephone interventions significantly reduced HbA1c (MD=-0.59, 95%CI -0.85 to -0.34, p<0.00001, I²=87%). Most effective: 16 follow-ups (MD=-0.92, p=0.02), 20-25min duration (MD=-1.23, p<0.001), half-month intervals (MD=-1.29, p=0.03). Also effective: 12 follow-ups (MD=-0.87, p<0.001), 10-15min duration (MD=-0.54, p=0.03), weekly intervals (MD=-0.93, p=0.02). No publication bias detected.

High heterogeneity (I²=87%). Need for high-quality RCTs to validate optimal protocols. Individual patient needs should guide customization.

Level of Evidence: I (Meta-Analysis)

“Nurse-led telephone follow-ups effectively enhance HbA1c control in T2DM patients”

Provides specific protocol parameters for telephone follow-up: 12-16 calls over intervention period, 10-25 min duration, weekly to half-month intervals. Directly applicable to remote follow-up component of ADA protocols.

Koo, D. J., Moon, S. J., Moon, S., et al. (2024). Long-term Glycemic Improvement After Home and Self-care Program (HELP) for Patients with Type 1 Diabetes: A Real-World based Cohort Study. Journal of Medical Internet Research, 26, e60023. https://doi.org/10.2196/60023

Peer Reviewed

To evaluate Home and Self-Care Program effects on glycemic control in patients with T1D after periodic structured education implementation

Home Health Care Model

Real-world based cohort study

HbA1c levels; CGM metrics for CGM users; follow-up at 3-month intervals for up to 24 months

119 participants with T1D aged >15 years (April 2020-March 2023)

HbA1c levels, continuous glucose monitoring (CGM) metrics (time in range, time below range), structured education sessions, remote support via smartphone app

Adjustment model with repeated measures; mean differences calculated at each follow-up visit from baseline

Baseline HbA1c 8.6%. HbA1c reduction: 1.63% at first follow-up (p<0.001, adjusted=1.69%, 95%CI 1.24-2.13%) to 1.23% at eighth follow-up (p=0.01, adjusted=1.28%, 95%CI 0.78-1.79%). Mean HbA1c maintained 7.33-7.62%. CGM users: time in range maintained 54.7-61.59% (HbA1c <7.6%). Time below range improved to recommended levels (≤4% for <70mg/dL, ≤1% for <54mg/dL).

Study specific to Type 1 diabetes; may not fully generalize to Type 2. Korean population; cultural factors may influence outcomes. Need for cost-effectiveness analysis.

Level of Evidence: III (Cohort study)

“The Home and Self-Care Program protocol for glycemic control is effective, producing significant improvement immediately and long-term maintenance effects”

Education: nursing/nutrition up to 4x/year, physician consultation up to 6x/year, remote support 12x/year. Demonstrates long-term sustainability of structured follow-up programs with remote support component.

Main Themes

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Theme 1: ADA Guideline Adherence and Clinical Practice Standards

ElSayed, N. A., Aleppo, G., Aroda, V. R., et al. (2022). Improving care and promoting health in populations: Standards of care in diabetes—2023. Diabetes Care, 46(1), 10–18. https://doi.org/10.2337/dc23-s001

Tiwari, D., & Aw, T. C. (2024). The 2024 American Diabetes Association guidelines on Standards of Medical Care in Diabetes: key takeaways for laboratory. Exploration of Endocrine and Metabolic Diseases, 2024, 158–166. https://doi.org/10.37349/eemd.2024.00013

Abukhalil, A. D., Muhanna, S. A., Madi, M. N., et al. (2024). Adherence to ADA Clinical Guidelines in Type 2 Diabetes Management in Public Health Clinics in Palestine. Patient Preference and Adherence, 18, 2667–2680. https://doi.org/10.2147/ppa.s494951

Tiwari, K., Bisht, M., Kant, R., & Handu, S. S. (2022). Prescribing pattern of anti-diabetic drugs and adherence to the American Diabetes Association’s (ADA) 2021 treatment guidelines. Journal of Family Medicine & Primary Care, 11(10), 6159–6164. https://doi.org/10.4103/jfmpc.jfmpc_458_22

Aldahmashi, H., Maneze, D., Molloy, L., & Salamonson, Y. (2024). Nurses’ adoption of diabetes clinical practice guidelines in primary care and the impacts on patient outcomes and safety: An integrative review. International Journal of Nursing Studies, 154, e104747. https://doi.org/10.1016/j.ijnurstu.2024.104747

Theme 2: Nurse-Led Interventions and Staff Competency Development

Dailah, H. G. (2024). The Influence of Nurse-Led Interventions on Diseases Management in Patients with Diabetes Mellitus: A Narrative Review. Healthcare, 12(3), 352. https://doi.org/10.3390/healthcare12030352

Jiang, L., Yan, J., Yao, J., et al. (2024). Nurse-led follow-up care versus routine health education and follow-up in diabetes patients: An effectiveness analysis. Medicine, 103(22), e38094. https://doi.org/10.1097/md.0000000000038094

Yunis, B., Pérez, P. E., Jose, J., & Moreno, I. M. (2024). Increasing Self-Efficacy for Management of Patients with Type 2 Diabetes Through an Advanced Practice Education Program for Primary Care Professionals. Nursing Reports, 14(4), 3830–3846. https://doi.org/10.3390/nursrep14040280

Murumba, R. G., Naman, R. O., Tuohy, C. A., White, P. A., & Wright, W. (2024). Assessment of adherence to ADA guidelines in a nurse practitioner–owned clinic. Journal of the American Association of Nurse Practitioners, 37(8), 462–470. https://doi.org/10.1097/jxx.0000000000001084

Okemah, J., Neunie, S., Noble, A., & Wysham, C. (2023). Impact on Knowledge, Competence, and Performance of a Faculty-Led Web-Based Educational Activity. Journal of Medical Internet Research Formative Research, 7, e49115. https://doi.org/10.2196/49115

Theme 3: Diabetes Self-Management Education and Support (DSMES) Interventions

Yimer, Y. S., Addissie, A., Kidane, E. G., et al. (2025). Effectiveness of diabetes self-management education and support interventions on glycemic levels. Frontiers in Clinical Diabetes and Healthcare, 6, e1554524. https://doi.org/10.3389/fcdhc.2025.1554524

Asmat, K., Froelicher, E. S., Dhamani, K. A., Gul, R., & Khan, N. (2024). Effect of patient-centered self-management intervention on glycemic control. Journal of Diabetes, 16(9), e13611. https://doi.org/10.1111/1753-0407.13611

Huang, Y., Li, S., Lu, X., Chen, W., & Zhang, Y. (2024). The Effect of Self-Management on Patients with Chronic Diseases. Healthcare, 12(21), e2151. https://doi.org/10.3390/healthcare12212151

Fracso, D., Bourrel, G., Jorgensen, C., et al. (2022). The chronic disease Self-Management Programme: A phenomenological study. Health Expectations, 25(3), 947–958. https://doi.org/10.1111/hex.13430

Höld, E., Grüblbauer, J., Wiesholzer, M., et al. (2022). Improving glycemic control through a peer support instant messaging service intervention (DiabPeerS). Trials, 23(1), 308. https://doi.org/10.1186/s13063-022-06202-2

Theme 4: Technology-Enhanced Diabetes Care and Remote Follow-Up Protocols

Ezeamii, V. (2024). Revolutionizing healthcare: How Telemedicine Is Improving Patient Outcomes. Cureus, 16(7), e63881. https://doi.org/10.7759/cureus.63881

Chen, Y., Zhou, T., Su, L., Guo, Y., & Ke, X. (2025). Effects of nurse-led telephone interventions on HbA1c levels in patients with type 2 diabetes. BioMed Central Nursing, 24(1), 1–10. https://doi.org/10.1186/s12912-025-02782-x

Koo, D. J., Moon, S. J., Moon, S., et al. (2024). Long-term Glycemic Improvement After Home and Self-care Program (HELP) for Patients with Type 1 Diabetes. Journal of Medical Internet Research, 26, e60023. https://doi.org/10.2196/60023

Graue, M., Igland, J., Haugstvedt, A., et al. (2023). Evaluation of an interprofessional follow-up intervention among people with type 2 diabetes in primary care. Public Library of Science ONE, 18(11), e0291255. https://doi.org/10.1371/journal.pone.0291255

Dineen, T. E., Bean, C., Cranston, K. D., et al. (2021). Fitness Facility Staff Can Be Trained to Deliver a Motivational Interviewing-Informed Diabetes Prevention Program. Frontiers in Public Health, 9, e728612. https://doi.org/10.3389/fpubh.2021.728612