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Postoperative stoma education is an essential aspect of care for all types of stoma formation because having a stoma impacts on every aspect of a person's life. This critical review of the literature explores stoma patients' needs and wants; postoperative education care guidelines; the role of ward link nurses; and care pathways. The findings from this review demonstrate that there is no national standard postoperative stoma care pathway, yet such pathways are a cost-effective means to improve patient outcomes and care. The review also identified that structured care pathways are not a new concept, but there is a lack of formal research to determine best practice in postoperative stoma education. In the UK, there is wide variation in practice and outcomes, which means that effectiveness cannot be accurately measured. The author has developed and implemented a multidisciplinary postoperative education pathway in line with a national need to further refine postoperative stoma care services to meet stoma patients' needs.

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BACKGROUND: Undergoing surgery for renal cell carcinoma can potentially compromise the mental well-being and overall quality of life of survivors. Long-term psychological education interventions that are delivered remotely through various modalities have shown promise in enhancing the psychological well-being and quality of life of cancer patients. This study investigates the effect of remote multimodal psychoeducational interventions on mental well-being and quality of life of renal cell carcinoma survivors. METHODS: A retrospective study was conducted to compare patients receiving remote psychological interventions (exposure group) with those receiving standard care (control group). Following the interventions, various data sets including general demographic information, and assessments from the Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD), the Brief Fatigue Inventory-Chinese version (BFI-C), the Distress Thermometer (DT), and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) were gathered and analysed for comparison. RESULTS: This study included 116 renal cell carcinoma survivors, with 52 in the exposure group and 64 in the control group. Baseline characteristics were not significantly different between the two groups (p > 0.05). After the intervention, the exposure group had significantly lower scores than the control group on HAMA (14.63 vs. 16.66, p < 0.001), HAMD (13.63 vs. 16.36, p < 0.001), BFI-C (52.31 vs. 57.65, p < 0.001), and DT (3.94 vs. 4.98, p < 0.001). Additionally, the exposure group had significantly higher total score of EORTC QLQ-C30 (69.22 vs. 65.59, p < 0.001) than the control group. CONCLUSIONS: Remote multimodal psychoeducational interventions demonstrate a notable impact in mitigating adverse emotions, exhaustion, and discomfort experienced by survivors of renal cell carcinoma. Such interventions should be actively promoted in clinical practice.

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OBJECTIVE: Spinal cord injury (SCI) severely affects motor, sensory, reflex, and other functions, impacting 250,000 to 500,000 individuals globally each year. Bladder voiding dysfunction, a prevalent and serious complication of SCI, results in significant morbidity and reduced quality of life. This study examines the impact of nurse-led clean intermittent catheterization combined with synchronous health education for family members on improving compliance in patients with SCI and bladder voiding dysfunction. METHODS: Eighty-four patients with urinary dysfunction post-SCI treated in our hospital from January 2023 to January 2024 were selected. Family members were assigned to a control group (n = 40) or an observation group (n = 44) based on their participation in nurse-led health education. Urinary tract management proficiency, satisfaction, compliance, and complications were observed and statistically analyzed in both groups on the 30th day after self-initiated intermittent catheterization. RESULTS: By the 30th day, the observation group exhibited significantly higher cognitive scores in urinary tract management than the control group (p < 0.001). Additionally, the observation group showed greater compliance in daily water intake (p = 0.018), proper timing (p = 0.018), and correct bladder function training (p = 0.004). The incidence of urinary tract infections was lower in the observation group (p = 0.018). Patient satisfaction in the observation group also exceeded that of the control group in all measured aspects and total scores (p < 0.001). CONCLUSIONS: Nurse-led synchronous health education for family members during clean intermittent catheterization significantly enhances patient compliance, reduces complications, and improves patient satisfaction.

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BACKGROUND: In recent years, there has been a significant increase in the survival rates of cancer patients. However, this has also led to an increase in side effects, such as dyspnoea, which can negatively impact of patients. We propose a programme for re-educating effort. The main objective is to test the effectiveness of this programme in improving respiratory symptoms and functionality in cancer patients. METHODOLOGY: Experimental, prospective, longitudinal, randomised study with a parallel fixed-assignment scheme (CG-IG). The patients were selected from the Medical Oncology Service of the University Hospital Complex of Salamanca (CAUSA), Spain. Two parallel intervention programmes were designed for the two study groups (Conventional Clinical Practice-Effort Re-education Programme). Primary variables: dyspnoea (MRC), functionality (Barthel); secondary variables: physical performance (SPPB) and functional capacity (ECOG) and the socio-demographic variables (age, sex, anatomopathological diagnosis, and number of treatment lines). RESULTS: The study sample consisted of 182 patients, with 12 excluded, resulting in a final sample size of n = 170. Sex distribution (CG: 52.9% male and 47.1% female; IG: 49.4% male and 50.6% female). The primary oncological diagnosis was lung cancer, and the most frequent tumour stages were III and IV. Statistically significant differences were found between the IG and CG scores (p < 0.001, d = 0.887, 95% CI) and between the IG and CG scores (p = 0.004, d = 0.358, 95% CI), indicating that the IG performed better. CONCLUSION: The results of this study support the beneficial effects of an exercise re-education programme, carried out by an interdisciplinary team in improving the autonomy of oncology patients with dyspnoea. TRIAL REGISTRATION: The clinical trial was registered in ClinicalTrials.gov (NCT04186754). (03 September 2019).

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BACKGROUND: Diverticular disease is a common gastrointestinal diagnosis with over 2.7 million clinic visits yearly. National guidelines from the American Society of Colon and Rectal Surgeons state that "the decision to recommend elective sigmoid colectomy after recovery from uncomplicated acute diverticulitis should be individualized." However, tools to individualize this decision are lacking. OBJECTIVE: This study aimed to develop an online educational decision aid (DA) to facilitate effective surgeon and patient communication about treatment options for recurrent left-sided diverticulitis. METHODS: We used a modified design sprint methodology to create a prototype DA. We engaged a multidisciplinary team and adapted elements from the Ottawa Personal Decision Guide. We then iteratively refined the prototype by conducting a mixed methods assessment of content and usability testing, involving cognitive interviews with patients and surgeons. The findings informed the refinement of the DA. Further testing included an in-clinic feasibility review. RESULTS: Over a 4-day in-person rapid design sprint, including patients, surgeons, and health communication experts, we developed a prototype of a diverticulitis DA, comprising an interactive website and handout with 3 discrete sections. The first section contains education about diverticulitis and treatment options. The second section clarifies the potential risks and benefits of both clinical treatment options (medical management vs colectomy). The third section invites patients to participate in a value clarification exercise. After navigating the DA, the patient prints a synopsis that they bring to their clinic appointment, which serves as a guide for shared decision-making. CONCLUSIONS: Design sprint methodology, emphasizing stakeholder co-design and complemented by extensive user testing, is an effective and efficient strategy to create a DA for patients living with recurrent diverticulitis facing critical treatment decisions.

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OBJECTIVE: Population-based studies of reasons for not participating in diabetes self-management education (DSME) are scarce. Therefore, we investigated what sociodemographic and disease-related factors are associated with participation in DSME, the reasons for not participating in DSME and how participants evaluate DSME. RESEARCH DESIGN AND METHODS: We used data from the nationwide survey "Disease knowledge and information needs-Diabetes mellitus 2017", which included a total of 1396 participants diagnosed with diabetes mellitus (diabetes; n = 394 DSME-participants, n = 1002 DSME-never-participants). Analyses used weighted logistic or multinominal regression analyses with bivariate and multivariable approaches. RESULTS: Participants were more likely to attend DSME if they had a medium (OR 1.82 [95%CI 1.21-2.73]),or high (OR 2.04 [95%CI 1.30-3.21]) level of education, had type 1 diabetes (OR 2.46 [1.24-4.90]) and insulin treatment (OR 1.96 [95%CI 1.33-2.90]). Participants were less likely to attend DSME if they lived in East Germany (OR 0.57 [95%CI 0.39-0.83]), had diabetes for >2 to 5 years (OR 0.52 [95%CI 0.31-0.88] compared to >5 years), did not agree that diabetes is a lifelong disease (OR 0.30 [95%CI 0.15-0.62], had never been encouraged by their physician to attend DSME (OR 0.19 [95%CI 0.13-0.27]) and were not familiar with disease management programs (OR 0.67 [95%CI 0.47-0.96]). The main reasons for non-participation were participant's personal perception that DSME was not necessary (26.6%), followed by lack of recommendation from treating physician (25.7%) and lack of information on DSME (20.7%). DSME-participants found DSME more helpful if they had a medium educational level (OR 2.06 [95%CI 1.10-3.89] ref: low level of education) and less helpful if they were never encouraged by their treatment team (OR 0.46 [95%CI 0.26-0.82]). DISCUSSION: Professionals treating persons with diabetes should encourage their patients to attend DSME and underline that diabetes is a lifelong disease. Overall, the majority of DSME participants rated DSME as helpful.

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Patients managing central venous catheters (CVCs) outside of hospitals need training in CVC care. Using 3 focus groups, the study identified themes in how health care personnel (HCP) prepare patients and their caregivers for CVC care at home. Four major themes and 25 nested subthemes were identified: (1) providing the right amount of education at the right time, (2) tailoring education to patient needs, (3) developing patient education tools, and (4) managing differences in recommendations to patients. HCPs in the study ensured patients and caregivers learn what they need to know when they need to know it, using appropriate patient education tools. Patients and caregivers are largely responsible for CVC care and central line-associated bloodstream infection prevention outside of acute care hospitals and long-term care settings, and HCP take seriously their obligation to provide them with appropriate education and tools to best enhance their ability to keep themselves safe.

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Objectives: To assess the impact of educational intervention by nurses guided by Orem's theory to reinforce the self-care abilities of patients experiencing myocardial infarction. METHODS: The prospective, quasi-experimental case-control study was conducted from September 2020 to April 2021 at Dr. Ruth K.M. Pfau Civil Hospital, Karachi, and comprised myocardial infarction and heart failure patients with comorbidities diabetes mellitus and hypertension. The patients were randomised into experiment group A and control group B. Group A received educational intervention one day before and one day after discharge in line with the American Heart Association guidelines. Two 30-45-minute sessions of seven modules were conducted. Group B received routine information from ward staff. Assessment was done at baseline and first month and second month post-intervention using the Heart Failure Self-Care Index version 6.2. Data was analysed using SPSS 21. RESULTS: Of the 80 patients, 40(50%) were in group A; 27(76.5%) males and 13(32.5%) females. The remaining 40(50%) patients were in group B; 20(50%) males and 20(50%) females. The overall age of the sample ranged 36-65 years and 48(60%) had a previous history of heart failure. The mean score of maintenance, management, confidence and overall self-care were significantly higher in group A compared to group B (p<0.05). Conclusion: Nursing self-care educational intervention based on Orem's theory was found to be highly effective among patients of myocardial infarction and heart failure with respect to their self-efficacy ability.

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While examining the social perspectives of chronic kidney disease (CKD) and its most common cause, diabetes, a common problem is spread of misleading information by unqualified people. This concerning trend makes it more difficult for patients to receive prompt and proper medical advice, which in turn further delays their referral to nephrologists and endocrinologists. In this communication, we highlight the challenges and consequences of this burning issue. We also propose the steps that various stakeholders and policy makers should take to contain this issue at the earliest.

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BACKGROUND: Patients' satisfaction with their treatment directly impacts the control of their diabetes. Quality of life is crucial for patients with diabetes mellitus to maintain long-term health and minimize complications. The current study aimed to evaluate the impact of diabetes education on quality of life (QoL) and treatment satisfaction of patients with type 2 diabetes mellitus. METHODS: The current study was a randomized controlled trial. Patients with type 2 diabetes who were attending the diabetes clinic for 1 year were recruited. The overall sample in this study was 364 participants; 182 controls 182 cases. The interventional and control group participants were assigned randomly by simple random sampling technique. Controls were managed per usual care while cases were managed per usual care plus education done by the researcher. Pre-structured standardized questionnaires were used to collect the data. Data were processed and analyzed by using SPSS; version 28. RESULTS: More than three-fourth of the participants; 76.4% were females. The average (±SD) age of the cases was 54.5 (±10) years, while was 56 (±9.8) years for controls. The overall median (IQR) years of DM diagnosis for all participants was 8 (4-14) years. The results showed a statistically significant difference between the mean satisfaction score from baseline to 12 months in the cases compared the controls (P < .001). Furthermore, there are statistically insignificant differences between the changes of mean overall QoL score from baseline to 12 months among the 2 groups. CONCLUSION: The education provided improved self-reported treatment-satisfaction among individuals with diabetes .A statistically insignificant differences in QoL between the 2 groups compared to baseline have been shown at the study end.The trial registration number is PACTR202311766174946 which was registered by pan African clinical trials registry, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=26928.

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Asthma is a chronic inflammatory airway disorder and is among the top ten causes of morbidity and mortality in Indonesia, highlighting the need for effective management strategies. This study aimed to evaluate changes in asthma knowledge levels before and after using the "Paru Sehat" smartphone application for digital education. A quasi-experimental study using a pre- and post-test design was conducted over three months at the outpatient clinic of Universitas Sumatera Utara Hospital, Medan, Indonesia, among asthma patients aged over 18 years. The patients completed the Patient Asthma Knowledge Questionnaire (PAKQ) before installing the "Paru Sehat" application to establish baseline knowledge. Once a week, patients received reminders to access materials covering an asthma overview, peak flow meter use, medication differences, and management techniques. After four weeks of intervention, the participants' knowledge was reassessed using the PAKQ. Data were analyzed using either paired Student's t-test or Wilcoxon test to assess the improvement in knowledge. The results showed increases in knowledge about asthma in general, asthma triggers, and asthma diagnosis domains, with the median score in each domain rising by one point (p=0.003, p=0.001, and p=0.002, respectively). The asthma management domain exhibited the largest change, with a median increase of two points (p<0.001). The total scores increased by an average of five points (p<0.001), indicating an overall improvement in patient knowledge about asthma. The "Paru Sehat" application demonstrated significant potential in enhancing asthma knowledge across multiple domains. Further research is warranted to explore the long-term effectiveness of the application in diverse populations and settings, ultimately contributing to improved asthma management and patient outcomes.

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BACKGROUND: Hypertension affects one-third of adults in the United States and is the leading risk factor for death. Underserved populations are seen disproportionately in the emergency department (ED) and tend to have worse blood pressure (BP) control. For adults, a lack of hypertension knowledge is a common barrier to hypertension control, while social support is a strong facilitator, and providing information that is culturally sensitive and relevant is especially important in this context. The youth experience increased confidence when given the responsibility to provide health education and care navigation to others. As such, we planned a randomized controlled trial (RCT) for the effectiveness of a digital youth-led hypertension education intervention for adult patients in the ED with hypertension, focusing on change in BP and hypertension knowledge. OBJECTIVE: In preparation for an RCT, we conducted a formative study to determine acceptable and easily comprehensible ways to present hypertension information to adults with hypertension and optimal ways to engage youth to support adults on how to achieve better hypertension control. METHODS: After creating an intervention prototype with 6 weekly self-guided hypertension online modules, we recruited 12 youth (adolescents, aged 15-18 years) for 3 focus groups and 10 adult ED patients with hypertension for individual online interviews to garner feedback on the prototype. After completing a brief questionnaire, participants were asked about experiences with hypertension, preferences for a hypertension education intervention, and acceptability, feasibility, obstacles, and solutions for intervention implementation with youth and adults. The moderator described and showed participants the prototyped intervention process and materials and asked for feedback. Questionnaire data were descriptively summarized, and qualitative data were analyzed using the template organizing style of analysis by 3 study team members. RESULTS: Participants showed great interest in the intervention prototype, thought their peers would find it acceptable, and appreciated its involvement of youth. Youth with family members with hypertension reported that their family members need more support for their hypertension. Youth suggested adding more nutrition education activities to the intervention, such as a sodium tracker and examples of high-sodium foods. Adults discussed the need for a hypertension support intervention for themselves and the expected benefits to youth. They mentioned the overwhelming amount of hypertension information available and appreciated the intervention's concise content presentation. They suggested adding more mental health and smoking cessation resources, information about specific hypertension medications, and adding active links for health care information. CONCLUSIONS: Based on focus groups and interviews with participants, a youth-led digital hypertension intervention is an acceptable strategy to engage both adults with hypertension and youth. Incorporating participant suggestions into the intervention may improve its clarity, engagement, and impact when used in a subsequent RCT.

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INTRODUCTION: Patient education programmes focusing on risk factor modification and lifestyle changes are well established as part of cardiac rehabilitation in patients with coronary artery disease (CAD). As participation rates are low, digital patient education programmes (DPE) are interesting alternatives to increase access. Understanding patients' perceptions of DPE are important in terms of successful implementation in clinical practice but are not well known. Therefore, the aim of this study was to assess patients' perceptions of using a DPE in terms of end-user acceptance and usability, perceived significance for lifestyle changes and secondary preventive goal fulfilment in patients with CAD. METHODS: This was a cross-sectional survey-based study. The survey was distributed to all 1625 patients with acute coronary syndrome or chronic CAD with revascularisation, who were registered users of the DPE between 2020 and 2022 as part of cardiac rehabilitation. The survey contained 64 questions about e.g., acceptance and usability, perceived significance for making lifestyle changes and secondary preventive goal fulfilment. Patients who had never logged in to the DPE received questions about their reasons for not logging in. Data were analysed descriptively. RESULTS: A total of 366 patients (mean age: 69.1 ± 11.3 years, 20% female) completed the survey and among those 207 patients (57%) had used the DPE. Patients reported that the DPE was simple to use (80%) and improved access to healthcare (67-75%). A total of 69% of the patients were generally satisfied with the DPE, > 60% reported that the DPE increased their knowledge about secondary preventive treatment goals and approximately 60% reported having a healthy lifestyle today. On the other hand, 35% of the patients would have preferred a hospital-based education programme. Among the 159 patients (43%) who had never used the DPE, the most reported reason was a perceived need for more information about how to use the DPE (52%). CONCLUSIONS: This study shows an overall high level of patient acceptance and usability of the DPE, which supports its continued development and long-term role in cardiac rehabilitation in patients with CAD. Future studies should assess associations between participation in the DPE and clinical outcomes, such as secondary preventive goal fulfilment and hospitalisation.

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INTRODUCTION: Adherence to COPD management strategies is complex, and it is unclear which intervention may enhance it. OBJECTIVES: We aim to evaluate the effectiveness of adherence-enhancing interventions, alone or compared to interventions, for patients with COPD. METHODS: This review comprises a component network meta-analysis with a structured narrative synthesis. We searched MEDLINE, Embase, CENTRAL, CINAHL and trial registries on 9 September 2023. We included controlled studies that explored adherence in patients with COPD. Two review authors independently performed the study selection, data extraction and the risk of bias assessment. We involved patients with COPD in developing this systematic review through focus group interviews and displayed the findings in pre-designed logic models. RESULTS: We included 33 studies with 5775 participants. We included 13 studies in the component network meta-analysis that explored adherence. It was mainly assessed through questionnaires. As a continuous outcome, there was a tendency mainly for education (standardised mean difference 1.26, 95% CI 1.13-1.38, very low certainty of evidence) and motivation (mean difference 1.85, 95% CI 1.19-2.50, very low certainty of evidence) to improve adherence. As a dichotomous outcome (e.g. adherent/non-adherent), we found a possible benefit with education (odds ratio 4.77, 95% CI 2.25-10.14, low certainty of evidence) but not with the other components. We included six studies that reported quality of life in the component network meta-analysis. Again, we found a benefit of education (mean difference -9.70, 95% CI -10.82- -8.57, low certainty of evidence) but not with the other components. CONCLUSIONS: Education may improve adherence and quality of life in COPD patients. Patient focus group interviews indicated that interventions that strengthen patients' self-efficacy and help them to achieve individual goals are the most helpful.

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Patients with diabetes have physical and psychological issues due to chronic illness. According to the guidelines of the Chinese Diabetes Society, after the diagnosis of patients with diabetes, they should receive routine health education, but this is the passive installation method of education. Nurses have made important contributions to the follow-up, education, and support of patients with diabetes and their families. The objective of this study was to evaluate the effectiveness of nurse-led follow-up care in routine health education and follow-up for patients with diabetes. Medical records of 721 patients with type 1 and type 2 diabetes were reviewed. Patients received nurse-led follow-up care including educational programs + Tai Chi exercises (patients received nurse-led follow-up care including educational programs for 6 months, n = 108), routine health education and follow-up + Tai Chi exercises (patients received routine health education and follow-up for 6 months, n = 205), or Tai Chi exercises only, but did not receive nurse-led follow-up care or routine health education and follow-up (patients received Tai Chi exercises only for 6 months, n = 408) for 6-months. The Zung Self-Rating Depression and Anxiety Scale and Summary of Diabetes Self-Care Activities were used to evaluate anxiety, depression, and self-care activities, respectively. Before the start of follow-up care (BFC), knowledge regarding diabetes and its threat was ≤1.75, anxiety and depression scores were ≥52 each, and self-care activities were ≤37. After 6 months of follow-up care, patients in the patients received nurse-led follow-up care including educational programs for 6 months improved their knowledge regarding diabetes and its threat, anxiety, depression, and self-care activities as compared to their before the start of follow-up care conditions and patients in the RF and patients received Tai Chi exercises only for 6 months at after 6 months of follow-up care conditions (P < .001 for all). Chinese type 1 or 2 diabetes patients had worse physical and psychological conditions and less knowledge regarding diabetes and its threat. 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 and self-care activities in diabetic patients (Level of Evidence: IV; Technical Efficacy: Stage 5).

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AIM: Explore Australian-Chinese immigrants' health literacy and preferences and engagement with translated diabetes self-management patient education materials. DESIGN: The cross-sectional survey was conducted with Australian-Chinese immigrants at risk or with type 2 diabetes recruited via health services, and diabetes and community organisations. METHODS: The survey had three parts: (1) diabetes screening; (2) sociodemographic information, clinical characteristics and preferences for translated materials; and (3) Functional, Communicative and Critical Health Literacy (FCCHL) Scale. RESULTS: Of 381 participants, 54.3% reported diabetes (n = 207), the remainder pre-diabetes or at risk (45.7%, n = 174); 34.1% male; mean age 64.1 years. Average total health literacy (FCCHL) scores were 35.3/56 (SD = 8.7). Participants with greater English proficiency reported higher health literacy (p < 0.001). This pattern also existed for functional (p < 0.001), communicative (p = 0.007) and critical (p = 0.041) health literacy subdomains. Health literacy scores did not differ significantly based on years of residence in Australia (all p > 0.05). Although the majority of participants (75.6%, N = 288) were willing to receive translated diabetes information, only a small proportion (19.7%, N = 75) reporting receiving such materials. CONCLUSION: There is a clear need for co-designed diabetes patient education materials that meet the needs and adequately reach Australian-Chinese immigrants. In particular, these materials must support people with limited English-language proficiency. IMPLICATIONS FOR NURSING PRACTICE: This study highlights important considerations for nurses seeking to improve diabetes care for Chinese immigrants when incorporating patient education materials as part of their nursing education.

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e-Health, defined as "the use of new information and communication technologies (ICT) to improve or support health and health care," has grown in popularity over recent years as a cost-efficient, rapidly adaptable tool to deliver health care education to a wide audience. In the field of vascular disease, for which early detection and risk factor management may greatly influence patient outcomes, application of e-Health educational resources may provide innovative solutions to facilitate evidence-based and patient-centered care provision of care; to enable patients to take a more active role in the management of their long-term vascular health conditions; and to augment their preparation for, and recovery from, surgical procedures.

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AIMS: This systematic review and network meta-analysis compared the effects of various diabetes self-management programs: Diabetes Self-Management Education (DSME), Diabetes Self-Management Support (DSMS), and Diabetes Self-Management Education and Support (DSMES). METHODS: We searched four electronic databases for eligible articles up to March 1, 2023. Only randomized controlled trials investigating the effects of DSME, DSMS, or DSMES on glycated haemoglobin (HbA1c) level, fasting blood glucose (FBG), total cholesterol (TC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) in adults with type 2 diabetes were included. Cochrane Risk of Bias 2.0 tool was used to assess each study quality, and Confidence in Network Meta-Analysis was applied to evaluate the certainty of the evidence. Data were pooled with a random-effects model under a frequentist framework. RESULTS: A total of 108 studies encompassing 17,735 participants (mean age 57.4 years) were analysed. DSMES, compared with usual care, significantly reduced HbA1c level (mean difference = -0.61%, 95% confidence interval [CI] = -0.74 to -0.49; certainty of evidence = moderate), FBG (-23.33 mg/dL; -31.33 to -15.34; high), TC (-5.62 mg/dL; -8.69 to -2.55; high), SBP (-3.05 mmHg; -5.20 to -0.91; high), and DBP (-2.15 mmHg; -3.36 to -0.95; high). Compared with DSME, DSMES showed significantly greater improvements in HbA1c levels (-0.23%; -0.40 to -0.07; high) and DBP (-1.82 mmHg; -3.47 to -0.17; high). DSMES was ranked as the top treatment for improving diabetes clinical outcomes (0.82-0.97) in people with type 2 diabetes. CONCLUSIONS: DSMES, in people with type 2 diabetes, yields the greatest improvement in the key clinical outcomes of HbA1c, fasting blood glucose, and blood pressure levels. Healthcare providers should incorporate the DSMES approach into their daily care routines. Approximately 30% of the studies reviewed raised some concerns about their quality, underscoring the need for high-quality studies in this area.

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