Effectiveness of nurse-led diabetes self-management education on medication adherence, dietary practices, and glycemic control among patients with type 2 diabetes mellitus: A narrative review

Abstract

Type 2 diabetes mellitus (T2DM) remains one of the fastest-growing chronic disease burdens worldwide, and suboptimal medication adherence, poor dietary practices, and inadequate glycemic control continue to undermine treatment outcomes despite advances in pharmacotherapy. Nurse-led diabetes self-management education (DSME) has emerged as a widely implemented, resource-appropriate strategy for closing this gap, particularly in primary care and low-resource settings where physician time is constrained. This narrative review synthesizes evidence, largely drawn from quasi-experimental and controlled clinical studies, on the effectiveness of nurse-led DSME in improving medication adherence, dietary self-care practices, and glycemic control among adults with T2DM. Across the reviewed literature, structured nurse-delivered education programs consistently improved diabetes knowledge, self-efficacy, and self-reported adherence behaviors, with the most consistent glycemic benefit observed at four to six months and beyond rather than immediately after program completion (Sun et al., 2025; Hailu et al., 2018; Tamiru et al., 2023). Medication adherence improved when education was combined with individualized counseling, action-planning, and follow-up contact (Farmer et al., 2012), while dietary outcomes were strongest when programs incorporated culturally tailored, patient-centered nutrition counseling rather than generic dietary advice (Mostafavi-Darani et al., 2020; Moghimi et al., 2023). Nurses' continuity of care, accessibility, and communication skills were repeatedly identified as mechanisms underlying these effects. However, considerable heterogeneity in intervention duration, delivery mode, outcome measurement, and follow-up length limits direct comparability across studies, and adherence to the interventions themselves was inconsistently measured. This review concludes that nurse-led DSME is an effective and scalable adjunct to standard diabetes care, but that greater standardization of intervention protocols, use of validated adherence and dietary measurement tools, and longer follow-up periods are needed to strengthen the evidence base and guide policy adoption