Frontiers in public health · 2025
Impact of nurse-led self-management education on type 2 diabetes: a meta-analysis.
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Sun Jiabao, Fan Zhenwei, Kou Mengyuan, Wang Xuewei, Yue Zhongmin, Zhang Min
Аннотация
BACKGROUND: Diabetes Self-Management Education (DSME) is a cornerstone strategy for improving glycemic control, yet its clinical effectiveness is often limited by suboptimal adherence. The aim of this study is to evaluate through meta-analysis the impact of nurse-led DSME on glycemic control, lipid profiles, and self-efficacy in adults with type 2 diabetes mellitus (T2DM).
METHODS: Following PRISMA 2020 guidelines, we systematically searched PubMed, EMBASE, and Web of Science databases (up to February 28, 2025). Inclusion criteria comprised: randomized controlled trials (RCTs) comparing nurse-led DSME (≥3 structured sessions) vs. usual care or other non-nurse-led interventions. Risk of bias was assessed using Cochrane RoB 2.0. Effect sizes [mean difference (MD) or standardized mean difference (SMD)] were pooled using R meta package with random-effects models (I 2 > 50%). Subgroup analyses and meta-regression were performed.
RESULTS: Eight RCTs (reporting HbA1c outcomes) were included. Meta-analysis demonstrated: (1) Glycemic control: nurse-led DSME significantly reduced HbA1c at 4-6 months (MD = -0.92, 95% CI: -1.44 to -0.41) and >6 months (MD = -0.54, 95% CI: -0.86 to -0.23; p < 0.05), but not at 0-3 months (MD = -0.22, 95% CI: -1.15 to 0.51). Fasting blood glucose (FBG) showed significant improvement (MD = -0.20, 95% CI: -0.36 to -0.03). (2) Self-efficacy: the intervention group demonstrated significantly enhanced self-efficacy (SMD = 1.48, 95% CI: 1.04-1.92). (3) Lipid profiles: high-density lipoprotein (HDL) increased significantly (MD = 0.27, 95% CI: 0.14-0.41), while total cholesterol (TC), triglycerides (TG), and low-density lipoprotein (LDL) showed no significant changes. (4) Considerable heterogeneity was observed (HbA1c: I 2 = 87.8%; self-efficacy: I 2 = 84.5%). Meta-regression suggested borderline significant influence of follow-up duration on effect size (p = 0.059). No significant publication bias was detected (Egger's test p = 0.116).
CONCLUSION: Nurse-led DSME effectively improves long-term glycemic control and self-efficacy while elevating HDL levels in T2DM patients, though standardization of intervention protocols is needed to reduce heterogeneity. This study supports integrating nurse-led models into diabetes management guidelines and recommends future research focus on long-term follow-up and cost-effectiveness analyses.
SYSTEMATIC REVIEW REGISTRATION: https://doi.org/10.37766/inplasy2025.7.0114, identifier: NPLASY202570114.
METHODS: Following PRISMA 2020 guidelines, we systematically searched PubMed, EMBASE, and Web of Science databases (up to February 28, 2025). Inclusion criteria comprised: randomized controlled trials (RCTs) comparing nurse-led DSME (≥3 structured sessions) vs. usual care or other non-nurse-led interventions. Risk of bias was assessed using Cochrane RoB 2.0. Effect sizes [mean difference (MD) or standardized mean difference (SMD)] were pooled using R meta package with random-effects models (I 2 > 50%). Subgroup analyses and meta-regression were performed.
RESULTS: Eight RCTs (reporting HbA1c outcomes) were included. Meta-analysis demonstrated: (1) Glycemic control: nurse-led DSME significantly reduced HbA1c at 4-6 months (MD = -0.92, 95% CI: -1.44 to -0.41) and >6 months (MD = -0.54, 95% CI: -0.86 to -0.23; p < 0.05), but not at 0-3 months (MD = -0.22, 95% CI: -1.15 to 0.51). Fasting blood glucose (FBG) showed significant improvement (MD = -0.20, 95% CI: -0.36 to -0.03). (2) Self-efficacy: the intervention group demonstrated significantly enhanced self-efficacy (SMD = 1.48, 95% CI: 1.04-1.92). (3) Lipid profiles: high-density lipoprotein (HDL) increased significantly (MD = 0.27, 95% CI: 0.14-0.41), while total cholesterol (TC), triglycerides (TG), and low-density lipoprotein (LDL) showed no significant changes. (4) Considerable heterogeneity was observed (HbA1c: I 2 = 87.8%; self-efficacy: I 2 = 84.5%). Meta-regression suggested borderline significant influence of follow-up duration on effect size (p = 0.059). No significant publication bias was detected (Egger's test p = 0.116).
CONCLUSION: Nurse-led DSME effectively improves long-term glycemic control and self-efficacy while elevating HDL levels in T2DM patients, though standardization of intervention protocols is needed to reduce heterogeneity. This study supports integrating nurse-led models into diabetes management guidelines and recommends future research focus on long-term follow-up and cost-effectiveness analyses.
SYSTEMATIC REVIEW REGISTRATION: https://doi.org/10.37766/inplasy2025.7.0114, identifier: NPLASY202570114.