Improving nursing care protocols for diabetic patients through a systematic review and meta-analysis of recent years

Table 1 Characteristics of included studies

Ref.	Study type and intervention groups	Follow-up period	Sample sizes for demographic data	HbA1c %, GM ± SD	FPG glucose in mg/dL, GM ± SD
Kim and Utz[39]	Randomized clinical trial	12 weeks			Not evaluated
	CG: Usual care		CG (n = 52): Female: 63.5%; Age median: 56 ± 10.0 yr	CG: Pre: 8.73 ± 1.43; Post: 6.74 ± 1.07
	EG1: DM management intervention based on social networks and health literacy-sensitive patient activation, self-care behaviours, and glucose control		EG1 (n = 52): Female: 40.4%; Age median: 46 ± 15.5 yr	EG1: Pre: 9.55 ± 1.66; Post: 6.98 ± 1.36
	EG2: DM management intervention based on phone calls		EG2 (n = 51): Female: 54.9%; Age median: 52 ± 17.0 yr	EG2: Pre: 9.05 ± 1.79; Post: 7.40 ± 1.90
Chen et al[13]	Randomised clinical trial	3 months
	CG: Follow-up was conducted through telephone or clinic visits every 2 weeks. Patients received routine health education, dietary instructions, and blood glucose monitoring during follow-up		CG (n = 45): Female: 44.44%; Age median: 45.4 ± 3.2	CG: Pre: 9.02 ± 1.94 Post: 7.99 ± 2.09	CG (mmol/L): Pre: 9.01 ± 0.19 Post: 8.01 ± 1.44
	EG: The EG received interactive health education based on the WeChat platform. An interactive healthcare team (physicians and nurses) was established to support patients via WeChat, providing disease education, daily life guidelines, and personalized consultation. This account sent out 2 messages per week with informative audiovisual material and provided an interactive space for asking questions and interacting with other participants		EG (n = 45): Female: 42.22%; Age median: 46.1 ± 3.1	EG: Pre: 9.05 ± 2.00; Post: 6.82 ± 1.69	EG (mmol/L): Pre: 8.94 ± 0.21; Post: 7.03 ± 2.04
Moradi et al[15]	Randomised clinical trial	3 months
	CG: Received only routine training		CG (n = 80): Female: 43%; Age: 47.3 ± 7.9	CG: Pre: 8.52 ± 1.57; Post: 8.54 ± 1.81	CG: Pre: 221 ± 102; Post: 216 ± 93
	EG: Educational intervention via mobile cells on foot care knowledge and foot care practices (daily check feet for cuts, redness, sores, ulcers, and blisters, daily washing and drying feet, using moisturizing creams to protect foot from dryness, using shoes and coverings properly, properly trimming toe nails, not cutting off the edge of toe nails, not tampering with the warts and crests, and visiting physicians regularly)		EG (n = 80): Female: 39%; Age: 48.11 ± 9.7	EG: Pre: 8.56 ± 1.65; Post: 7.39 ± 1.44	EG: Pre: 239 ± 96; Post: 180 ± 74
Wu et al[17]	Randomised clinical trial	6 months
	CG: Received general education about T2DM using a conventional teaching mode		CG (n = 46): Female: 52.2%; Age: 61.1 ± 10.0	CG: Pre: 8.0 ± 0.6 Post: 7.4 ± 0.7	CG: Pre: 167.6 ± 28.1 Post: 165.0 ± 42.6
	EG: The EG received educational sessions using Steno Balance Cards, which involves guided group dialogue		EG (n = 46): Female: 54.4%; Age: 62.5 ± 6.1	EG: Pre: 8.1 ± 0.7; Post: 6.8 ± 0.8	EG: Pre: 174.9 ± 19.9; Post: 131.2 ± 32.3
Qasim et al[22]	Randomised clinical trial	3 months			Not evaluated
	CG: Routine DM counselling provided by trained DM clinic nurses. Counselling sessions were conducted in groups of 6-8 people, with each session lasting between 30-40 min		CG (n = 61): Female: 44.8%; Age 30-44: 24.1%; Age 45-60: 75.9%	CG: Pre: 10 ± 1.8 Post: 9.1 ± 1.8
	EG: 4 education sessions each (in groups of 6-8 participants) lasting 40 min each		EG (n = 62): Female: 57.4%; Age 30-44: 25.9%; Age 45-60: 74.1%	EG: Pre: 9.0 ± 1.5; Post: 8.2 ± 1.4
Elgerges[37]	Randomised clinical trial	3 months
	CG: Usual care		CG (n = 50): Female: 44%; Age: 54.30 ± 6.69	CG: Pre: 7.7 ± 1.8 Post: 7.5 ± 1.5	CG: Pre: 168.0 ± 61.8 Post: 158.6 ± 52.5
	EG: Therapeutic education workshop by a multidisciplinary team (doctor, a nurse, a psychologist, and a dietician) The intervention session lasted for a period of 6 h. The topics covered were the sugar journey, definition of DM, types, causes, consequences, treatment, and self-management in terms of medication compliance, self-monitoring of blood glucose, diet, physical activity, foot care, and stress management. The pedagogical methods used were video, concept map, posters, demonstrations, role-plays, and lectures. During the session, healthy snacks were distributed, and a pedometer and educational kit were offered. Every 2 weeks, a phone call was made to the experimental group to check their practices and if they had any questions		EG (n = 50): Female: 56%; Age: 54.58 ± 6.58	EG: Pre: 8.40 ± 1.52 Post: 6.80 ± 0.70	EG: Pre: 181.1 ± 60.8; Post: 140.3 ± 29.5
Alison and Anselm[36]	Randomised clinical trial	12 months			Not evaluated
	CG: Received normal clinic visits with consultations by a medical officer		CG (n = 50): Female: 66%; Age: 52.38 ± 11.39	CG: Pre: 10.04 ± 1.29 Post: 9.56 ± 1.65
	EG: Received four or more DM Medication Therapy Adherence Clinic visits in addition to normal clinic visits		EG (n = 50): Female: 58%; Age: 52.66 ± 9.35	EG: Pre: 10.46 ± 1.64 Post: 8.69 ± 1.79
Subramanian et al[40]	Randomised clinical trial	15 days		Not evaluated
	CG: Routine DM counselling provided. The routine care was consultation with the doctor and a follow-up once every 2 weeks to get antidiabetic medications; every 3rd month, a routine blood test was performed		CG (n = 35)		CG: Pre: 160.57 ± 58.7 Post: 161.57 ± 55.86
	EG: Received nurse-led intervention on video-assisted teaching regarding nature of the disease condition including, diet, medication, hand and leg exercises, and home care management for 30 min. Then a demonstration of hand and leg exercise was done followed by return demonstration by the participants		EG (n = 35) More than 40% were in the age group of > 60 years and > 60.0% were females. No significant disparity between experimental and control groups was observed		EG: Pre: 146.70 ± 54.63; Post: 132.80 ± 42.87
Hoyo et al[38]	Randomised clinical trial	18 months			Not evaluated
	CG: Nurses provided treatment as usual		CG (n = 198): Female: 71%; Age: 71.5 ± 10.5	CG: Pre: 8.65 ± 1.40 Post: 8.84 ± 1.38
	EG: Motivational nurse-led proactive monthly intervention by telephone, centred in a psychoeducational personalized monitoring protocol		EG (n = 198): Female: 71.6%; Age: 71.4 ± 10.3	EG: Pre: 8.72 ± 1.49 Post: 7.03 ± 1.09

CG: Control group; DM: Diabetes mellitus; EG: Experimental group; EG1: Experimental group 1; EG2: Experimental group 2; FPG: Fasting plasma glucose; GM: Geometric mean; HbA1c: Glycated haemoglobin; SD: Standard deviation; T2DM: Type 2 diabetes mellitus.