Nurse-Led Programs Focusing on Social Support for People with Type 2 Diabetes Mellitus: A Scoping Review *

Programas centrados en el apoyo social para personas con diabetes mellitus tipo 2 dirigidos por enfermeros: revisión de alcance **




Article

10.5294/aqui.2024.24.1.2


[0000-0002-1502-7594] Isabela Mendonça Rodrigues dos Santos[****]

[0000-0002-8453-2543] Isaura Letícia Palmeira Tavares Rolim[*****]

[0000-0002-7675-412X] Aurean D’Eça Júnior[******]

[0000-0003-3234-2833] Maria Almira Bulcão Loureiro[*******]

[0000-0002-7966-8075] Diogo Matheus Barros da Silva[********]

[0000-0002-6801-1940] Geysa Santos Góis Lopes[*********]

[****] Universidade Federal do Maranhão, Brazil isabela.mrs@discente.ufma, https://orcid.org/0000-0002-1502-7594

[*****] Universidade Federal do Maranhão, Brazil leticia.isaura@ufma.br, https://orcid.org/0000-0002-8453-2543

[******] Universidade Federal do Maranhão, Brazil aurean.junior@ufma.br, https://orcid.org/0000-0002-7675-412X

[*******] Universidade Federal do Maranhão, Brazil almira.maria@discente.ufma.br, https://orcid.org/0000-0003-3234-2833

[********] Universidade Federal do Maranhão, Brazil silva.diogo@discente.ufma.br, https://orcid.org/0000-0002-7966-8075

[*********] Rede Sarah Hospitalar, Brazil geysagois@hotmail.com, https://orcid.org/0000-0002-6801-1940

Author notes:

Conflicts of interest:

Conflicts of interest None declared.

Date received: 20/6/2023

Date accepted: 03/11/2023

Abstract

Introduction:

Nurse-led programs have a determinant role in the engagement of individuals in the self-management of type 2 diabetes mellitus (T2DM), as they contribute to improving quality of life. Self-management assisted by social support is vital, especially as it describes the importance of nurses in promoting health for people with T2DM, as this intervention can help reduce the consequences and progression of the disease.

Objective:

To map programs focused on nurse-led social support for people with T2DM.

Materials and Methods:

This is a scoping review in line with the methodological guidelines of the Joanna Briggs Institute. The search descriptors used were “autocuidado” (self-care), “intervenção liderada por enfermeiro” (nurse-led intervention), and “diabetes mellitus tipo 2” (type 2 diabetes mellitus), with searches in the Web of Science, Medline, CINAHL, Capes Theses and Dissertations Catalog, Scopus, JBI Evidence Synthesis, PsycINFO, and the Portuguese Open Access Scientific Repositories databases conducted between February and March 2022. The eligibility criteria were studies published within the last 10 years, in English, Spanish, and Portuguese, covering the individual’s experience in programs focused on self-management through nurse-led social support.

Results:

A total of 12 studies were included, all of which were published in the United States, England, and Iran, focusing on social support for self-management in people with T2DM, and centered on care facilities for people with chronic diseases. It was found that most nurse-led programs have been implemented in developed countries and that their main characteristic is their emphasis on social cognitive theory. The population was characterized by being mostly women, aged over 22, with a low level of education.

Conclusions:

The study met the proposed objective by demonstrating that, despite the low implementation cost with high social and economic returns, the development of these programs is still scarce. The need for further studies focusing on emotional levels, such as depression and anxiety, is highlighted.

Keywords (Source: DeCS)

Social Support, Nursing Care, Social Programs, Self-Management, diabetes mellitus type 2

Resumen

Introducción:

los programas dirigidos por enfermeras desempeñan un papel fundamental a la hora de implicar a las personas en el autocontrol de la diabetes mellitus tipo 2 (DM2), ya que repercuten en la mejora de la calidad de vida. El autocontrol respaldado por el apoyo social es crucial, especialmente porque describe la importancia de los profesionales de enfermeria en la promocion de la salud de las personas con diabetes mellitus tipo 2 (DM2), dado que esta intervencion puede ayudar a reducir las consecuencias y el empeoramiento de la enfermedad.

Objetivo:

mapear los programas centrados en el apoyo social para personas con DM2 dirigidos por enfermeros.

Materiales y método:

una revision de alcance que siguio las directrices metodologicas del Instituto Joanna Briggs. Los descriptores de busqueda utilizados fueron “autocuidado”, “intervencion dirigida por enfermeros”, “diabetes mellitus tipo 2”, con busqueda en la Web of Science, Medline, CINAHL, Catalogo de Tesis y Disertaciones de la Capes [Coordinacion de Perfeccionamiento de Personal de Nivel Superior], Scopus, JBI Evidence Synthesis, PsycINFO y Repositorios Cientificos de Acceso Abierto de Portugal, entre febrero y marzo de 2022. Los criterios de elegibilidad fueron estudios publicados en los ultimos 10 anos, en ingles, espanol y portugues, que cubrieran la experiencia individual de programas dirigidos por profesionales de enfermeria centrados en la autogestion a traves del apoyo social.

Resultados:

se incluyeron 12 estudios, publicados en Estados Unidos, Inglaterra e Iran, centrados en el apoyo social para la autogestion de personas con DM2 y en entornos de atencion a personas con enfermedades cronicas. Se observo que la mayoria de los programas dirigidos por enfermeros se aplican en paises desarrollados y tienen como caracteristica principal el enfasis en la teoria cognitiva social. El publico se caracterizo por ser mayoritariamente femenino, mayor de 22 anos y con bajo nivel de estudios.

Conclusiones:

el estudio respondio al objetivo propuesto demostrando que, a pesar del bajo costo de implementacion con alto retorno social y economico, el desarrollo de estos programas aun es considerado escaso. Se reitera la necesidad de nuevos estudios que enfaticen niveles emocionales como la depresion y la ansiedad.

Palabras clave (Fuente: DeCS):

Apoyo social, atencion de enfermeria, programas sociales, automanejo, diabetes mellitus tipo 2

Introduction

Type 2 diabetes mellitus (T2DM) represents a public health problem due to its high prevalence, mortality, and morbidity rates, with a resulting increase in costs for the healthcare system. All these negative health outcomes, both at the individual and collective levels, prompt the development of innovative strategies to promote effective self-management (1).

Thus, certain decisions in therapeutic management have an impact on the quality of life of people with T2DM since many of the complications progress to disability. Furthermore, the treatment of complications leads to higher costs, both for the individual and the healthcare system (2). For this reason, the guidelines of scientific organizations dedicated to the study of T2DM recommend that people should participate in education programs for diabetes mellitus self-care (EPDMS). These programs train individuals so that they become knowledgeable enough to make decisions and, simultaneously, induce self-management (3). EPDMS thus benefit and improve this population’s health conditions (4).

Self-management is defined as the individual’s ability, alongside their families, community, and healthcare professionals, to manage the symptoms, treatment, and psychosocial, cultural, and spiritual changes resulting from chronic conditions. For this purpose, the processes related to self-management include goal setting and self-monitoring, reflective thinking, decision-making, planning and engaging in specific health behaviors, self-assessment, and management of physical, emotional, and cognitive responses regarding health behavior changes (5).

One of the ways to support self-management is by adopting the perspective of social support. Social support is a care network provided by people who are close to an individual or professionals, regardless of where they receive treatment. This form of support provides knowledge and affection, which enables learning, security, and improved self-esteem. These feelings contribute to the continuity of activities regularly, leading to the individual refraining from quitting treatment or withdrawing from society (6).

Those who receive and, especially, perceive the social support provided by their support network can face these adversities with more commitment since they know who to resort to and from whom to receive the necessary help. This helps them to self-manage a pathology’s treatment, emphasizing that this is a delicate period, with individual adaptations and resignations (7). From this perspective, interventions based on social support are capable of modifying health conditions, because they reduce the individual’s mental and physical stress, as well as reducing behaviors that are harmful to their health (8).

According to the literature, nursing stands out as the profession best suited to provide self-management support, since its importance lies in the fact that it strengthens the bond for treatment, with knowledge and planning of routines to manage a chronic condition (9). In this sense, specific programs led by nurses that offer social support to teach self-management skills stand out (9). Thus, it is necessary to learn more about nurse-led programs that aim to promote self-management through social support in the field of T2DM, since there is currently a lack of information available on their characteristics. Furthermore, understanding these programs’ current state of the art would be useful for informing future research.

Additionally, nursing interventions focused on social support to help the self-management of patients with T2DM contribute to the health-disease process in a way that enables them to manage their health condition. Consequently, it is necessary to carry out this scoping review to synthesize the current scientific evidence on the subject.

The main objective of this review is to map the nature and extent of published scientific production and grey literature related to nurse-led programs aimed at supporting self-management of care of people with T2DM through social support. It has the following specific objectives: To list the programs focusing on social support for people with T2DM led by nurses; to describe the contents of these programs; and to identify the results related to them.

Materials and Methods

This is a scoping review, whose purpose is to map, explore, and describe the literature in the research field and the conceptual limits of the theme addressed. It was done by observing the methodological guidelines of the Joanna Briggs Institute (JBI). Thus, the following steps were followed, according to the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews (Prisma-ScR) version 2020: defining and aligning the objectives and questions; developing and aligning the inclusion criteria with the objective and guiding question; describing the planned approach for searching for evidence, selecting and extracting data, and presenting the evidence; searching for the evidence; selecting the evidence; extracting the evidence; evaluating the evidence; presenting the results; summarizing the evidence about the review’s purpose, establishing conclusions, and noting any implications arising from the findings (10).

Registration Protocol

The protocol for the preparation of this review is registered on the Open Science Framework (OSF) platform and can be accessed via the following link: https://osf.io/4wvt6.

Identification of the Guiding Question

The guiding question formulated was the following: What nurse-led programs exist to support self-management in people with T2DM through social support, and what are their characteristics?

Furthermore, the PCC (population, concept, and context) mnemonic strategy was used to integrate the studies in this review. Therefore, the population consists of adults with T2DM; the concept of nurseled social support programs; and the context is primary healthcare or the community.

Eligibility Criteria

The eligibility criteria adopted were: studies published with the proposed theme in English, Spanish, and Portuguese; complete articles, theses, and dissertations available online; any study, regardless of methodological design (qualitative, quantitative, or mixed), that explores the participant’s experience in programs aimed at supporting the self-management of DM through social support and led by nurses; studies with participants aged 18 or over, diagnosed with T2DM, conducted in the primary health care setting, and with program interventions led by nurses.

Search Strategy

The search for studies was performed in the following databases: Web of Science, Medline (PubMed), Cinahl (EBSCO), Capes Catalog of Theses and Dissertations, Scopus, JBI Evidence Synthesis, PsycINFO (APA), and Open Access Scientific Repositories in Portugal between February 23 and March 17, 2022. Afterward, the reference lists of the included studies were manually searched to identify any relevant studies. The search strategies used for each database are shown in Table 1 and were devised with the assistance of two librarians with expertise in the health field and systematized reviews.

Table 1

Search Strategies Used in the Explored Databases. Brazil, 2022

Database Search Strategy Search Date Retrieved Articles
Cinahl (EBSCO) ((MM “Self Care”) OR (MM “Self-Management”)) AND (MM “Support, Social/UT”) AND (MM “Community Programs”) AND (MM “Nurses”) AND (MM “Diabetes Mellitus, Type 2”). 17/03/2022 11
Open Access Scientific Repositories of Portugal (RCAAP) “Social support” AND diabetes 17/03/2022 181
Web of Science (“Self Care” OR “self management”) AND (“Social Support” OR “Social Care” OR “Online Social Support” OR “Perceived Social Support” OR “Perceived Social Supports”) AND (“nurse-led education” OR “nurse- delivered intervention” OR “nurse-led intervention” OR “program development” OR “nurse-led program”) AND (“diabetes” OR “diabetes mellitus” OR “diabetes mellitus, Type 2” OR “Diabetes Mellitus, Type II” OR “Type 2 Diabetes Mellitus” OR “Type 2 Diabetes” OR “Diabetes, Type 2”) 23/02/2022 3
Scopus (“Self Care” OR “self management”) AND (“Social Support” OR “Social Care” OR “Online Social Support” OR “Perceived Social Support” OR “Perceived Social Supports”) AND (“nurse-led education” OR “nurse- delivered intervention” OR “nurse-led intervention” OR “program development” OR “nurse-led program”) AND (“diabetes” OR “diabetes mellitus” OR “diabetes mellitus, Type 2” OR “Diabetes Mellitus, Type II” OR “Type 2 Diabetes Mellitus” OR “Type 2 Diabetes” OR “Diabetes, Type 2”). 23/02/2022 24
PsycINFO (“Self Care” OR “self management”) AND (“Social Support” OR “Social Care” OR “Online Social Support” OR “Perceived Social Support” OR “Perceived Social Supports”) AND (“nurse-led education” OR “nurse- delivered intervention” OR “nurse-led intervention” OR “program development” OR “nurse-led program”) AND (“diabetes” OR “diabetes mellitus” OR “diabetes mellitus, Type 2” OR “Diabetes Mellitus, Type II” OR “Type 2 Diabetes Mellitus” OR “Type 2 Diabetes” OR “Diabetes, Type 2”). 23/02/2022 14
JBI Evidence Synthesis Self Care AND Social Support AND nurse led AND diabetes Type 2. 09/03/2022 62
Capes Catalog of Theses and Dissertations “Suporte social” AND “Diabetes” 17/03/2022 1429
PubMed (“Self Care” [MeSH Terms] OR “Self Care” [Text Word] OR “self management” [Text Word]) AND (“Social Support” [MeSH Terms] OR “Social Care” [Text Word] OR “Online Social Support” [Text Word] OR “Perceived Social Support” [Text Word] OR “Perceived Social Supports” [Text Word]) AND (“nurse-led education” [Text Word] OR “nurse-delivered intervention” [All Fields] OR “nurse-led intervention” OR “program development” [All Fields] OR “nurse-led program” [All Fields]) AND (“diabetes” OR “diabetes mellitus” OR “diabetes mellitus, Type 2” OR “Diabetes Mellitus, Type II” OR “Type 2 Diabetes Mellitus” OR “Type 2 Diabetes” OR “Diabetes, Type 2”) 09/03/2022 19

[i]Source: Search data (2022).

Study Selection

After searching the databases, all the studies were exported to a reference manager (EndNote). Duplicate articles were removed both manually and using an automation tool. It should be noted that the descriptors were adapted for each database, by using synonyms to find the greatest number of studies.

Next, the titles and abstracts were screened based on the inclusion criteria with the help of the Rayyan Systematic Reviews web/mobile app, so that two authors could independently and blindly screen the title/abstract and full text. In the event of any doubts, a third author would read the manuscript and decide whether or not to include it. Publications that met the eligibility criteria were retrieved in full.

Data Mapping

A form was designed by the author to extract the data. A pretest was then carried out to assess the need for adjustments. The data extracted included author, title, publication year, study country, journal name, document type, language, study objective, study setting, methods, population/sample size, inclusion criteria, exclusion criteria, collection instrument/technique, program results/impacts, conclusions, participants’ social characteristics, participants’ clinical characteristics, program/intervention duration, core theoretical model, resources used, program implementation, and user satisfaction assessment.

Compiling, Summarizing, and Reporting the Results

A descriptive analysis of the information related to nurse-led programs and their characteristics was carried out. The evidence was synthesized based on the research questions. A table was prepared with data allocated to the studies included in the review and another table with existing programs. Additionally, a figure was prepared with the basic theoretical model of the interventions. The search steps are represented in the flow diagram of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (Prisma-ScR), which is an extension of the scoping review.

Results

Literature Search

Initially, 1,743 publications were identified, as shown in Figure 1. After removing 10 duplicate studies, the titles and abstracts were then screened, resulting in a sample containing 12 documents for full reading. Subsequently, seven publications were excluded for failing to meet the eligibility criteria, which left five publications eligible for analysis. During the review of the references in the included studies, it was found that it was necessary to incorporate seven additional documents. As a result, this review consisted of 12 studies after the inclusion of the relevant documents.

Figure 1

Study identification and inclusion process. Prisma-ScR flowchart

1657-5997-aqui-24-01-e2412-gf1.png

Source: Own elaboration.

Most of the selected studies were frequently carried out more than five years ago (n = 8) in developed countries such as the United States, England, and Iran (n = 6), as shown in Table 2, which presents the main characteristics of the studies included in this review.

Table 2

Studies included in the scoping review by author, type of study, title, country, and year of publication. Brazil, 2022

Author Type of Study Title Country Year of Publication
Klein HA, Jackson SM, Street K, Whitacre JC, Klein G Article: systematic review + meta- analysis Diabetes self-management education: Miles to go United States 2012
Pereira DA, Costa NMSC, Sousa ALL, Jardim PCBV, Zanini CRO Article: randomized controlled clinical trial Efeito de intervenção educativa sobre o conhecimento da doença em pacientes com diabetes mellitus Brazil 2012
Parker D, Clifton K, Shams R, Young J Article: systematic review The effectiveness of nurse-led care in general practice on clinical outcomes in adults with type 2 diabetes Australia 2012
Mahdizadeh M, Peyman N, Thagipour A, Esmaily H Article: randomized controlled clinical trial Effect of health education program on promoting physical activity among diabetic women in Mashhad, Iran: Applying social cognitive theory Iran 2013
Bertolin DC Thesis: randomized controlled clinical trial Estresse, modos de enfrentamento e aceitação da doença de pessoas com diabetes mellitus tipo 2 participantes de um programa educativo como envolvimento de um familiar: ensaio clínico randomizado Brazil 2013
Tang PC, Overhag JM, Chan AS, Brown NL, Aghighi B, Entwistle MP et al. Article: clinical trial controlado e randomizado Online disease management of diabetes: Engaging and motivating patients online with enhanced resources-diabetes (EMPOWER-D), a randomized controlled trial The United States 2013
Villas Boas LCG, Pace AE Thesis: randomized controlled clinical trial Contribuição do apoio social familiar nos resultados das intervenções educativas junto às pessoas com diabetes mellitus tipo 2: ensaio clínico controlado randomizado Brazil 2014
Gomides DS Dissertation: longitudinal observational study Resultados de intervenções para o cuidado do diabetes mellitus com foco no apoio social: estudo longitudinal Brazil 2016
Murray E, Sweeting M, Dack C, Pal K, Modrow K, Hudda M et al. Article: randomized controlled clinical trial Web-based self-management support for people with type 2 diabetes (HeLP- Diabetes): Randomised controlled trial in English primary care England 2017
Golnaz A, Kim LS, Shariff GS, Said S, Sanaz A, Mosayeb M et al. Article: double-blind randomized clinical trial Effect of a nurse-led diabetes self- management education program on glycosylated hemoglobin among adults with type 2 diabetes Iran 2018
Hadjiconstantinou M Thesis: systematic review and meta- analysis + focus groups The development of an online emotional support programme, to improve diabetes related distress and well-being in type 2 diabetes England 2018
Van Puffelen AL, Rijken M, Heijmans MJWM, Nijpels G, Schellevis Article: randomized clinical trial Effectiveness of a self-management support program for type 2 diabetes patients in the first years of illness: Results from a randomized controlled trial The Netherlands 2019

[i]Source: Research data (2022).

Regarding the study designs, there was a prevalence of randomized clinical trials (n = 8). The others were systematic reviews plus meta-analysis (n = 2), a systematic review (n = 1), and a longitudinal observational study (n = 1). As for document type, eight were articles, three were theses, and one was a dissertation.

Study Characteristics

Nurse-led programs were implemented in the following locations: general care clinics (n = 6), specialized care services for people with chronic illnesses (n = 3), and university hospitals (n = 3), as shown in Table 3. It is noted that the programs are designed to improve glycemic control and, simultaneously, achieve significant results in terms of lipid profile, blood pressure, regular physical activity, adequate nutrition, emotional stability, social interaction and, consequently, self-management.

Table 3

Nurse-led programs focusing on social support for people with type 2 diabetes by author, intervention site, results achieved, and population assisted.

Author Intervention Site Intervention Results Population Assisted
Klein HA, Jackson SM, Street K, Whitacre JC, Klein G Randomly assigned A significant reduction in blood glycated hemoglobin levels. Age (mean): ND Sex: ND Education: ND
Pereira DA, Costa NMSC, Sousa ALL, Jardim PCBV, Zanini CRO Referral service for hypertension treatment Increased knowledge of diabetes mellitus. Age (mean): 65.8 years Sex: Female Education: 8 years of education
Parker D, Clifton K, Shams R, Young J General/family practice environment Improvement in clinical parameters: Changes in systolic and diastolic blood pressure (BP), body mass index (BMI), cholesterol levels, HbA1c (glycated hemoglobin), and fasting glycemia. Age: >18y Sex: ND Education: ND
Mahdizadeh M, Peyman N, Thagipour A, Esmaily H Healthcare centers in Mashhad City, eastern Iran In the intervention group (IG), light physical activity and sedentary behavior decreased from 56.1 % (23 individuals) to 14.6 % (6 individuals) in the next stage. There was a significant improvement over time in terms of physical activity (increase in the mean number of minutes practiced per week). Adherence to physical activity was higher in the groups due to the social support received, mainly from family, friends, and exercise partners. Age (mean): 48.37 years Sex: Female Education: ND
Bertolin DC Diabetes outpatient clinic at a tertiary level healthcare university hospital unit The most commonly mentioned coping methods are cognitive restructuring, information-seeking, medium acceptance of the disease, low perception of stress, and some level of stress (in the resistance stage of the disease). Age (mean): 60.4 years Sex: Female Education: A minimum of 0 and maximum of 17 years of education
Tang PC, Overhag JM, Chan AS, Brown NL, Aghighi B, Entwistle MP et al. Palo Alto Medical Foundation, a non-profit health organization The IG had significantly better diabetes management than the control group (CG) in the first 6 months. There was no significant difference after 12 months. The IG had significantly better management of LDL cholesterol at 12 months. There was no statistically significant difference in BP management, weight, and Framingham risk at 12 months. Idade: > 18 years Sex: Male Education: >12 years of education
Villas Boas LCG, Pace AE Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP) There were no statistically significant differences after carrying out the interventions for perceived self-efhcacy, knowledge about diabetes, medication adherence, and perceived social support. For the self-care variable, the CG performed better than the IG in one behavior related to eating and in two related to physical activity. Regarding the clinical variables, the CG had a lower body mass index and lower abdominal circumference in women. Metabolic management: there were no statistically significant differences, but there was a reduction in glycated hemoglobin in favor of the intervention group. Age (mean): 60.43 years Sex: Female Education: < 9 years
Gomides DS Outpatient clinic for diabetes treatment at a tertiary care hospital There were no differences between the groups for the variables BP, waist circumference, BMI, glycated hemoglobin, fasting plasma glucose, self-care activities, knowledge about the disease, and self-efhcacy. The timeframe was defined as baseline, the end of the interventions, and 24 months after the interventions. When comparing the times, there was a reduction in BP and glycated hemoglobin and an increase in BMI and abdominal circumference in both groups. Self-care knowledge and activities increased immediately after the interventions had been carried out and decreased after two years in both groups. Self-efhcacy was maintained in the IG and reduced in the CG after two years and at the end of the interventions. Interventions including social support had no difference between the groups and over time, through descriptive analysis, there was an improvement in self- efhcacy, which was sustained after two years in the IG. Group educational interventions were effective in improving glycemic control and BP two years after the interventions had been carried out. For the knowledge variables about the disease and self-care, the results suggest the need for educational reinforcement over time. Age: from 45 to 84 years Sex: Female Education: From 0 to 17 years of education
Murray E, Sweeting M, Dack C, Pal K, Modrow K, Hudda M et al. 21 general practices in England combining urban, suburban, and rural practices The IG participants had lower glycated hemoglobin (HbA1c) than those in the CG. There were no significant overall differences between the groups in the diabetes-related stress score, measured by the problem areas in diabetes (PAID) scale. However, for participants who had been diagnosed with diabetes more recently, it indicated a beneficial impact of the intervention on this group. Age: 65 years Sex: Male Education: ND
Golnaz A, Kim LS, Shariff GS, Said S, Sanaz A, Mosayeb M et al. Urban primary and secondary endocrine outpatient clinic located in a university hospital in the city of Ilam, Iran The IG patients had a significant improvement in glycated hemoglobin, BP, body weight, efhcacy expectancy, outcome expectancy, and diabetes self- management behaviors. Age (mean): 54.2 ± 11.8 years (ranging from 22 to 69 years) Sex: Female Education: 9 years of education
Hadjiconstantinou M Leicester Diabetes Centre Online support led by healthcare professionals was associated with positive well-being outcomes compared to those with non-professional support. Individually, several studies found significant improvements in well-being measurements. This was not supported by the meta-analysis for the outcome measurements of depression and distress. Age (mean): 53.4 years Sex: Female Education: ND
Van Puffelen AL, Rijken M, Heijmans MJWM, Nijpels G, Schellevis General practice clinics in the Netherlands. Immediately after the program, the IG presented a significantly greater increase in physical activity and fruit and vegetable intake. Six months after the intervention, these effects had disappeared. Regarding diabetes-related suffering, no immediate or six-month effects were found. The baseline levels of self-care seemed to be slightly higher in the IG, but not significantly higher. Six months after the intervention, the differences in empowerment were still present, even though healthy behaviors had decreased. Considering distress, there were no significant changes, as levels of distress were low even before the intervention had been carried out. Age (mean): 63.5 years Sex: Male Education: 12 years of education

[i]Source: Research data (2022).

[ii]Key: ND - not defined.

The participants’ characteristics indicate a mean age of 54.2} 11.8 years (between 22 and 69 years), with a prevalence of women (n = 7), with a low level of education, having studied for a total of nine years (n = 8).

The studies found on emotional support covered programs consisting of individual, face-to-face counseling, followed by a collective approach and dynamics with family/friends. To consolidate learning, phone calls were made (Table 4). Therefore, the programs converged on an educational basis -with instructions in face-to-face appointments and via phone calls- with a strong influence of affective aspects, since the person with diabetes would need to be the protagonist of their decisions, but there was also family interaction. On average, the interventions lasted 12 months, with a maximum of 36 months and a minimum of 1 month.

Table 4

Programs by Author, Type of Intervention, and Duration

Author Type of Intervention Duration
Klein HA, Jackson SM, Street K, Whitacre JC, Klein G Rules and procedures: Rules concerning diet and exercise. Rules for procedures, such as using a diary to record daily glucose levels. Affective: Encouragement and motivation to build trust. Social and situational: Approach focused on managing social and situational factors. Strategies that encompass planning meals on vacation and in restaurants. Complex cognition: Use of mental models or other cognitive strategies to support the understanding of diabetes, which are used to moderate blood glucose levels. Three categories: 13 weeks or less, 14-26 weeks, 27 weeks or more.
Pereira DA, Costa NMSC, Sousa ALL, Jardim PCBV, Zanini CRO The IG participated in 12 educational meetings over six months, held every two weeks and lasting an average of two hours. The first two educational meetings were held to identify the learning needs and previous knowledge about the disease among the research participants. A pre-established script was used for the discussion, which aimed to identify the patients’ knowledge of diabetes, the difhculties caused by the disease, and their perception of what could help with treatment. Organization of educational activities: a teaching plan was devised. Each plan used distinctive resources, such as pictures, phrases written by the patients themselves, posters, songs, walks, questions, and verbal expressions of meaningful experiences. 6 months
Parker D, Clifton K, Shams R, Young J Care is guided by nurses who are recognized as having a leadership role in the care of patients with T2DM compared to care provided by general practitioners. Not defined.
Mahdizadeh M, Peyman N, Thagipour A, Esmaily H The training program has been introduced. Introductory session: The rules have been announced. First session: Discussion regarding a healthy lifestyle. Second session: Discussion about problems and the search for alternatives to overcome barriers. Third session: Assigning objectives and their importance in achieving favorable results. Fourth session: Dialogue about having a regular program and planning physical activity. Fifth, sixth, and seventh sessions: Walking program and practical training course in physical activity. 7 sessions (4 theoretical and 3 practical) in 1 month (each session ≈ 60 min)
Bertolin DC Intervention with people with diabetes: performed in groups, using conversation maps. It is a tool that aims to empower people to make decisions. It provides discussions and dynamics in groups of up to 10 people. Maps were used, focusing on how the body and diabetes work (map 1), healthy eating and physical activity (map 2), monitoring blood glucose (map 3), and achieving insulin-related goals (map 4). A total of four meetings were held. Intervention with family members of people with diabetes: Through phone calls. Weekly calls were made, using the motivational interviewing technique. In this technique, the professional establishes an empathetic and collaborative relationship with the person. It follows pre-established protocols and uses the social cognitive theory. The topic of the conversation maps from the group meetings is addressed. A total of 17 calls were made. 23 months
Tang PC, Overhag JM, Chan AS, Brown NL, Aghighi B, Entwistle MP et al. 1st) Home glucose meter readings with graphical feedback; 2nd) Comprehensive report of the patient’s specific diabetes status; 3rd) Nutritional and workout records; 4th) Insulin record; 5th) Online messaging with the patient’s healthcare team; 6th) Nursing care manager and nutritionist providing advice and medication management, and 7th) Short personalized texts and educational videos provided electronically by the healthcare team. 12 months
Villas Boas LCG, Pace AE IG: Educational intervention with the participation of the family caregiver through phone calls. Returns occur every three months. A second assessment was done at 12 months. CG: No family member participation. Group educational interventions for people with T2DM: A maximum of eight participants. Approach carried out based on diabetes mellitus conversation maps. This tool aims to empower the individual to self-manage. The topics covered followed those available in Portuguese (how the body and diabetes work; healthy eating and physical activity; medication treatment; blood glucose monitoring; and achieving insulin-related goals). Educational interventions for family caregivers of people with T2DM: Phone calls following motivational interviews with a technique designed to generate collaborative empathy. Topics previously established by the diabetes conversation maps were discussed. A total of 17 calls lasting an average of eight minutes each have been made. Approximately 12 months
Gomides DS Educational interventions that provide information related to the disease and the self-care activities required for treatment, using visual and interactive tools based on the social cognitive theory, whose key concept is personal belief in one’s ability to perform certain tasks (self-efhcacy). The study times were baseline (T0), end of interventions (T12), and 24 months after completion (T36).
Murray E, Sweeting M, Dack C, Pal K, Modrow K, Hudda M et It is an application developed specifically for people with T2DM. The contents present in this application include information about diabetes, how diabetes is treated, possible complications from diabetes, possible impacts of diabetes on relationships at home and work, dealing with unusual situations such as parties, holidays, travel, or shift work, and what lifestyle changes will improve health, skills, and behavior change. Special modules cover behavior change, healthy eating, weight loss, being more physically active, quitting smoking, moderating alcohol consumption, managing medication, glycemic management, and BP management. In addition, content on emotional well-being and sharing experiences between users is available. Possibility of receiving monthly notifications with relevant news about diabetes. 12 months
Golnaz A, Kim LS, Shariff GS, Said S, Sanaz A, Mosayeb M et al. The participants in the intervention group received a booklet at the beginning of the program, whose content was used throughout the intervention to guide learning, development, and discussion or it was used to create resources for self-guided learning. Within the first four weeks of the intervention, participants were invited to watch four weekly 10-minute films on the prevention of short- and long-term complications (session 1), physical activity, daily foot care (session 2), healthy eating (session 3), and healthy living with diabetes (session 4). Four group discussion sessions were held at weekly intervals, but the schedule was flexible, and attendance was limited to 10 participants for each session. These sessions were held weekly during the first four weeks of the intervention. Each session lasted 120 minutes. All group members were encouraged to attend each session. Group members who missed a session received a follow-up from the moderator before the next session. At the last meeting of the group session, all group members were handed a list of home phone numbers and encouraged to ask for help if necessary. Two months following the end of the group discussion sessions, the intervention participants received a phone call once a week. Each follow-up call lasted approximately 15 to 20 minutes. At the end of the intervention, the CG participants were handed an educational booklet and films. 3 months
Hadjiconstantinou M Techniques for behavior change: To provide information; tracking/self-monitoring; to provide motivation; to provide feedback; goal setting; problem-solving; action planning; social support; emotional regulation training, and immediate review of behavioral goals. A minimum of 6 months and a maximum of 18 months.
Van Puffelen AL, Rijken M, Heijmans MJWM, Nijpels G, Schellevis It consists of three monthly two-hour interactive sessions and a follow-up session three months after the last session. The sessions were led by two nurses specializing in diabetes or nurses who received four hours of training and a detailed manual describing the content of the program and its underlying theories to be used during the sessions. The participating patients and their partners received a booklet containing basic information on diabetes, (homework) assignments, and theoretical and practical information on the topics discussed throughout the course (both books are available in Dutch from the author). The CG participants were invited to a single two-hour educational lecture, in which they received information about living with diabetes from a medical perspective. A professor of general practice and diabetes care provided information about the course of diabetes (including treatment options and possible complications) and the latest developments in diabetes research, according to the classic didactic method. 8 months

[i]Source: Research data (2022).

Regarding the basic theoretical model used by the programs, most followed the social cognitive theory (n = 3), conversation maps (n = 2), the common sense self-regulation theory (n = 2), the self-efficacy theory (n = 1), and motivational interviewing (n = 1). It is worth noting that the studies that were not mentioned correspond to the fact that they did not present their respective basic models and/or clarified the theoretical framework.

Analysis and Discussion

Evidence Summary

The present study found studies conducted in England, the United States, Iran, Australia, and the Netherlands on programs focused on social support for the self-management of people with T2DM, which were led by nurses and centered on care facilities for people with chronic diseases (9, 11-15).

It is worth noting that in these countries, care for people with diabetes is performed in a unique way and with a holistic approach (16). In developing countries such as Brazil, this approach is still in its infancy, despite efforts to improve care for this population, which has increased significantly over the years (17). Factors such as adequate spending of financial resources on healthcare services, continued training processes and engagement of professionals, as well as technological support and priority on conflict management may be associated with the differences mentioned between these regions (18-20).

In addition, strategies for patients’ attendance and commitment to the treatment of chronic diseases are related to family engagement and effective professional intervention, which highlights the importance of social support in achieving these goals. Such support is an essential tool for promoting improvements in health and interpersonal relationships, which leads to improved cognitive performance, and negative emotional reactions management -e.g., anxiety, and offers behavioral analysis (21, 22). The literature highlights the key role played by nursing professionals in primary care in health education activities and self-management through evidence-based practices (23).

In the present study, the findings regarding the theoretical framework that integrates social support into the main strategic interventions were the social cognitive theory (an active pedagogical strategy that determines that individuals influence and are influenced by observational learning [13, 24-26]); conversation maps (a tool subdivided into four stages, delivered to patients via images and metaphors reproduced on a card table with specific topics [27]); the self-efficacy theory (which determines that commitment, depending on personal will and ability, is decisive in preventing or managing the disease [28]); motivational interviewing (evidence-based counseling, in which healthcare professionals help people adopt targeted treatment recommendations [29]); and the common sense self-regulation theory (which provides strategies aimed at finding out how people feel and think about the disease [30]).

These theories can lead to several benefits for patients, such as a reduction in sedentary lifestyles, which has an impact on BMI control and abdominal circumference in women, a better understandingand acceptance of the disease, as well as stress reduction and increased consumption of fruit and vegetables (13, 24, 25). Thus, knowledge of these theoretical models can enable them to be implemented through low-cost programs and favor care processes with a reduction of risks and problems (31, 32).

A study published in the Revista de Medicina da Universidade de São Paulo showed that the perception of social support and family functionality were positive and there was a significant relationship between glycemic levels and information on the adequate management of T2DM in elderly males, which highlights the importance of family support in the therapeutic management of the disease. Nurse-led programs focused on promoting social support and family integration can promote better engagement between patients and their families and, consequently, contribute to improved self-care, healthy eating habits, and physical activity (33- 35). In addition, it is worth highlighting the inclusion of people with T2DM in support groups and educational activities, as this allows for joint interaction, and sharing experiences and feelings (36).

Regarding the multidisciplinary approach, nutritional interventions focused on fruit and vegetable intake and physical exercise programs were noted (15, 25, 37). In the field of nursing, the use of online tools was the main form of intervention and satisfactory results were achieved in terms of glycated hemoglobin values, fasting glycemia, BP levels, and anthropometric data (9, 14, 24, 31, 37-39, 44). It is worth pointing out that, in the field of primary care, nutritional monitoring associated with an adequate diet has led to the best short-term results with a balanced diet specific to each individual (40).

Regarding physical training programs for people with T2DM, these provided greater benefits by improving insulin sensitivity and glycated hemoglobin, which resulted in lower postprandial hyperglycemic peaks. The recommendation to practice physical exercise between 150 and 300 minutes (light to moderate) or 75 to 150 minutes (intense) has an impact on muscle strength and greater endurance capacity in these individuals, which can improve functional capacity and body maintenance (41). In addition, the professional support provided to recently diagnosed patients has benefits, such as reducing stress levels, especially in those who have been diagnosed within less than five years, and who are more resistant to accepting the disease (13, 15, 31, 44).

However, it is worth noting that, although self-management is effective in changing the cognition of people with T2DM, contributing to behavioral change and emotional perception, the maintenance of these behaviors still seems to be insufficient in the long term; therefore, an approach with individuals who have been diagnosed for longer is also essential, as it ensures continuity of care, reduces the possibility of chronic complications such as neuropathy, retinopathy, renal and neurological damage (25, 42).

The present review found that online programs and phone-based approaches under the guidance and leadership of a nurse were more likely to lead to adherence by participants. This can be justified by the fact that technological resources make communication easier, although access to these devices must be considered (9, 12- 15, 24, 25, 31, 39, 43, 44).

Thus, due to the complexity of the treatment, effective adherence by patients becomes a challenge not only for them but also for the healthcare team and family members. Consequently, comprehensive support and reframing of these individuals’ lifestyle habits must have an impact to promote the practice of effective self-care, as well as conscious decision-making with empowerment through cognitive restructuring (25, 44-47).

As such, the social importance of nurse-led programs for individuals with T2DM is materialized as an important alternative in the follow-up of these individuals in terms of risk reduction, adequate self-care management, and satisfactory family support, which contributes to personal satisfaction and lower demand for healthcare services (9, 48-50).

Limitations and Strengths

Although the methodological evaluation of studies is not a stage covered by the scoping review methodology, this can influence the results. The study was limited to the English, Portuguese, and Spanish languages, which may represent a selection bias. Thus, programs from other languages/cultures are not represented in this study. In addition, the studies did not clarify the follow-up and monitoring of the participants included in them, which hinders identifying and characterizing them in the medium and long term.

The strengths of the review include the rigorous and transparent approach adopted to select relevant studies, conducted in line with the Prisma-ScR guidelines. The strengths also lie in the collaboration of a multidisciplinary team of reviewers and the collaboration of librarians with expertise in systematic and scoping reviews to devise the search string.

Conclusions

Based on the results presented, it was found that nurse-led social support programs for self-management are patient- and family- centered and also use playful and educational auditory or visual strategies and can be based on collective and face-to-face sessions and phone calls. The main results of these programs were improved glycemic control, hemodynamics, and lipid profile. In addition, there has been an improvement in emotional and behavioral parameters, especially in the perception of stress and self-management.

Although there is a tendency for an increase in the number of these programs, there are still gaps that warrant attention; there is a need for future studies focused on emotional levels, such as depression and anxiety, as there was no unanimity on these findings. These psycho-emotional aspects can negatively influence the physiological and metabolic parameters of patients with T2DM. Furthermore, there is a need to conduct studies with individuals who have been diagnosed for longer, as there was a prevalence of individuals who had been diagnosed less than five years ago.

Nurse-led programs focusing on social support seem to be an intervention that can lead to more effective self-management, meeting people’s real needs and, consequently, achieving positive health outcomes in the T2DM setting. The relevance of this type of study in following up with participants in the medium and long term is emphasized to highlight the benefits of the proposed interventions.

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JB Moreira ES Muro LA Monteiro DH Iunes BB de Assis CL Chaves E de Efeito do grupo operativo no ensino do autocuidado com os pes de diabeticos: ensaio clinico randomizadoRev esc enferm USP202054e03624https://doi.org/10.1590/s1980-220x2019005403624

36. Klein HA, Jackson SM, Street K, Whitacre JC, Klein G. (2013). Diabetes self-management education: miles to go. Nursing Research and Practice. 2013:581012. DOI: https://doi.org/10.1155/2013/581012

HA Klein SM Jackson K Street JC Whitacre G Klein Diabetes self-management education: miles to goNursing Research and Practice2013581012581012https://doi.org/10.1155/2013/581012

37. Parker D, Clifton K, Shams R, Young J. The effectiveness of nurse-led care in general practice on clinical outcomes in adults with type 2 diabetes. JBI library of systematic reviews. 2012;10(38):2514-58. DOI: https://doi.org/10.11124/jbisrir-2012-33

D Parker K Clifton R Shams J Young The effectiveness of nurse-led care in general practice on clinical outcomes in adults with type 2 diabetesJBI library of systematic reviews2012103825142558

38. Tang PC, Overhag JM, Chan AS, Brown NL, Aghighi B, Entwistle MP et al. Online disease management of diabetes: Engaging and motivating patients online with enhanced resources-diabetes (EMPOWER-D): A randomized controlled trial. Journal of the American Medical Informatics Association. 2013;20(3):526-34. DOI: https://doi.org/10.1136/amiajnl-2012-001263

PC Tang JM Overhag AS Chan NL Brown B Aghighi MP Entwistle Online disease management of diabetes: Engaging and motivating patients online with enhanced resources-diabetes (EMPOWER-D): A randomized controlled trialJournal of the American Medical Informatics Association2013203526534https://doi.org/10.1136/amiajnl-2012-001263

39. Namazi N, Esmaeili S, Ahmadikhatir S, Razi F, Nasli-Esfahani E, Larijani B. Nutrition and diet therapy in diabetes mellitus: A roadmap based on available evidence. J Diabetes Metabolic Dis. 2021;20(2):1913-8. DOI: https://doi.org/10.1007/s40200-021-00876-2

N Namazi S Esmaeili S Ahmadikhatir F Razi E Nasli-Esfahani B Larijani Nutrition and diet therapy in diabetes mellitus: A roadmap based on available evidenceJ Diabetes Metabolic Dis202120219131918https://doi.org/10.1007/s40200-021-00876-2

40. Kanaley JA, Colberg SR, Corcoran MH, Malin SK, Rodriguez NR, Crespo C J et al. Exercise/physical activity in individuals with type 2 diabetes: A consensus statement from the American College of Sports Medicine. Med Scienc Sports Exercise. 2022;54(2):353-68. DOI: https://doi.org/10.1249/MSS.0000000000002800

JA Kanaley SR Colberg MH Corcoran SK Malin NR Rodriguez J Crespo C Exercise/physical activity in individuals with type 2 diabetes: A consensus statement from the American College of Sports MedicineMed Scienc Sports Exercise2022542353368https://doi.org/10.1249/MSS.0000000000002800

41. Neves Junior TT, Rego-de Queiroz AA, Araujo CE, Assis SCJ, Nobrega ETM, Perfil clinico y sociodemografico de usuarios con enfermedades cronicas en atencion primaria de salud. Enferm. glob. [Internet]. 2023 [citado 21 jun. 2023];22(69):245-82. DOI: DOI: https://doi.org/10.6018/eglobal.512211

TT Neves Junior AA Rego-de Queiroz CE Araujo SCJ Assis ETM Nobrega Perfil clinico y sociodemografico de usuarios con enfermedades cronicas en atencion primaria de saludEnferm. glob.202321 jun. 20232269245282 DOI: https://doi.org/10.6018/eglobal.512211

42. Bohnert KL, Zellers JA, Jeong H J, Chen L, York A, Hastings M K. Remote research: Resources, intervention needs, and methods in people with diabetes and peripheral neuropathy. Journal of Diabetes Science and Technology. 2023;17(1):52-8. DOI: https://doi.org/10.1177/19322968221103610

KL Bohnert JA Zellers J Jeong H L Chen A York K Hastings M Remote research: Resources, intervention needs, and methods in people with diabetes and peripheral neuropathyJournal of Diabetes Science and Technology20231715258https://doi.org/10.1177/19322968221103610

43. Kokoszka A. Treatment adherence in patients with type 2 diabetes mellitus correlates with different coping styles, low perception of self-influence on disease, and depressive symptoms. Patient Preference and Adherence. 2017;11:587-95. DOI: https://doi.org/10.2147/PPA.S124605

A Kokoszka Treatment adherence in patients with type 2 diabetes mellitus correlates with different coping styles, low perception of self-influence on disease, and depressive symptomsPatient Preference and Adherence201711587595https://doi.org/10.2147/PPA.S124605

44. Mahdizadeh M, Peyman N, Thagipour A, Esmaily H. Effect of health education program on promoting physical activity among diabetic women in Mashhad, Iran: Applying social cognitive theory. J Res Health Sci. 2013;13(1):90-7.

M Mahdizadeh N Peyman A Thagipour H Esmaily Effect of health education program on promoting physical activity among diabetic women in Mashhad, Iran: Applying social cognitive theoryJ Res Health Sci20131319097

45. Carvalho LK da CAA, Ibiapina TF, Rodrigues M da CVA, Leite MAE, Lopes de CM et al. Capacitacao de enfermeiros na Estrategia Saude da Familia: analise do processo de educacao permanente para o Sistema Unico de Saude. Nursing. 2018;21(247):2506-12. DOI: https://doi.org/10.36489/nursing.2018v21i247p2506-2512

CAA Carvalho LK da TF Ibiapina CVA Rodrigues M da MAE Leite CM Lopes de Capacitacao de enfermeiros na Estrategia Saude da Familia: analise do processo de educacao permanente para o Sistema Unico de SaudeNursing20182124725062512https://doi.org/10.36489/nursing.2018v21i247p2506-2512

46. Giovanella L, Mendonca MHM de, Buss PM, Gadelha CAG, Galvao LAC et al. De Alma-Ata a Astana. Atencao primaria a saude e sistemas universais de saude: compromisso indissociavel e direito humano fundamental. Cad Saude Publica 2019;35(3):e00012219. DOI: https://doi.org/10.1590/0102-311x00012219

L Giovanella MHM de Mendonca PM Buss CAG Gadelha LAC Galvao De Alma-Ata a Astana. Atencao primaria a saude e sistemas universais de saude: compromisso indissociavel e direito humano fundamentalCad Saude Publica2019353e00012219https://doi.org/10.1590/0102-311x00012219

47. Pereira VS, Souza CA de, Louro TQ, Oliveira ES de, Lima DM, Silva RCL da, Marta CB. Avaliacao de Tecnologias em Saude: Estado da Arte. Saud Coletiv. 2019;9(51):2035-40. DOI: https://doi.org/10.36489/saudecoletiva.2019v9i51p2035-2040

VS Pereira CA de Souza TQ Louro ES de Oliveira DM Lima RCL da Silva CB Marta Avaliacao de Tecnologias em Saude: Estado da ArteSaud Coletiv201995120352040https://doi.org/10.36489/saudecoletiva.2019v9i51p2035-2040

48. Teston EF, Spigolon DN, Maran E, Santos A de L, Matsuda LM et al. Perspectiva de enfermeiros sobre educacao para a saude no cuidado com o Diabetes Mellitus. Rev Bras Enferm. 2018;71(supl. 6):2899-907. DOI: https://doi.org/10.1590/0034-7167-2018-0396

EF Teston DN Spigolon E Maran L Santos A de LM Matsuda Perspectiva de enfermeiros sobre educacao para a saude no cuidado com o Diabetes MellitusRev Bras Enferm201871628992907https://doi.org/10.1590/0034-7167-2018-0396

49. Rawshani A, Rawshani A, Franzen S, Sattar N, Eliasson B et al. Risk factors, mortality, and cardiovascular outcomes in patients with Type 2 Diabetes. N Engl J Med. 2018;379(7):633-44. DOI: https://doi.org/10.1056/NEJMoa1800256

A Rawshani A Rawshani S Franzen N Sattar B Eliasson Risk factors, mortality, and cardiovascular outcomes in patients with Type 2 DiabetesN Engl J Med20183797633644https://doi.org/10.1056/NEJMoa1800256

50. Cesarino CB, Borges PR, Ribeiro R de CHM, Ribeiro DF, Kusumota L. Avaliacao do risco cardiovascular de pacientes renais cronicos segundo criterios de Framingham. Acta Paul Enferm. 2013;26(1):101-7. DOI: https://doi.org/10.1590/S0103-21002013000100016

CB Cesarino PR Borges CHM Ribeiro R de DF Ribeiro L Kusumota Avaliacao do risco cardiovascular de pacientes renais cronicos segundo criterios de FraminghamActa Paul Enferm2013261101107https://doi.org/10.1590/S0103-21002013000100016

[6] This work was conducted with the support of the “Edital N. 21/2018 - Procad/Amazonia,” funding provided by CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior), an agency linked to the Brazilian Ministry of Education, grant number: n.88881.200531/2018-01

[7] Este trabajo fue realizado con el apoyo de “Edital n.21/2018 - Procad/Amazonia”. Financiado por medio de CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior), una agencia vinculada al Ministerio de Educación de Brasil, concedido con el número: n.88881.200531/2018-01

[8] Santos IMR, Rolim ILTP, D’Eça A, Loureiro MAB, Silva DMB, Lopes GSG. Nurse-led programs focusing on social support for people with type 2 diabetes mellitus: A scoping review. Aquichan. 2024;24(1):e2412. DOI: https://doi.org/10.5294/aqui.2024.24.1.2

Appendices

Appendix A. Data Extraction Form

STUDYCHARACTERISTICS
Authors
Title
Publication year
Study country
Journal name
Document type
Language
Study objective
Study scenario
Methods
Population/sample size within the evidence source (if applicable)
Inclusion criteria
Exclusion criteria
Data collection instruments/techniques
Results (program/intervention impact)
Conclusions/key aspects that relate to the research question
PROGRAM CHARACTERISTICS
PARTICIPANTS
Social (age, housing, marital status)
Clinical
INTERVENTION/PROGRAM CHARACTERISTICS
Program/intervention duration
Baseline theoretical model
Resources employed (material/ pedagogical, and human)
Program/intervention implementation
PROGRAM RESULTS
Program impact
User satisfaction evaluation

Annex A

OSF Platform Registration Protocol

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Programas com foco no suporte social para pessoas com diabetes mellitus tipo 2 liderados por enfermeiros: scoping review***

Resumo

Introdução:

os programas liderados por enfermeiros desempenham um papel fundamental no engajamento do individuo na autogestao do diabetes mellitus tipo 2 (DM2), pois impactam na melhoria da qualidade de vida. A autogestao apoiada pelo suporte social torna-se crucial, sobretudo por descrever a importancia do enfermeiro na promocao da saude da pessoa com DM2, tendo em vista que essa intervencao pode contribuir para reduzir as consequencias e os agravamentos da doenca. Objetivo: mapear os programas com foco no suporte social para pessoas com DM2 liderados por enfermeiros.

Materiais e método:

revisado de escopo que seguiu as diretrizes metodologicas do Joanna Briggs Institute. Utilizou-se como descritores de busca “autocuidado”, “intervencao liderada por enfermeiro”, “diabetes mellitus tipo 2”, com busca nos bancos de dados Web of Science, Medline, CINAHL, Catalogo de Teses e Dissertacoes da Capes, Scopus, JBI Evidence Synthesis, PsycINFO e Repositorios Cientificos de Acesso Aberto de Portugal, entre fevereiro e marco de 2022. Os criterios de elegibilidade foram estudos publicados nos ultimos 10 anos, em ingles, espanhol e portugues, abrangendo a experiencia do individuo em programas com foco na autogestao por meio do suporte social liderados por enfermeiros.

Resultados:

12 estudos incluidos, publicados nos Estados Unidos, na Inglaterra e no Ira, com foco no suporte social de apoio a autogestao de pessoas com DM2 e com concentracao em locais de atendimento as pessoas com doencas cronicas. Observou-se que a maioria dos programas liderados por enfermeiros e implementada em paises desenvolvidos e apresenta como caracteristica principal enfase na teoria social cognitiva. O publico se caracterizou por ser maioria mulheres, faixa etaria de adultos maiores de 22 anos, com baixa escolaridade.

Conclusões:

o estudo respondeu ao objetivo proposto ao demonstrar que, apesar do baixo custo para a implementacao com alta devolutiva social e economica, ainda e considerado escasso o desenvolvimento desses programas. Reitera-se a necessidade de estudos posteriores com enfase nos niveis emocionais, como depressao e ansiedade.

Introdução

O diabetes mellitus do tipo 2 (DM2) representa um problema de saude publica, devido a sua alta prevalencia e a elevados índices de mortalidade e morbidade, com consequente aumento dos custos para o sistema de saude. Todos esses resultados negativos em saude, tanto na esfera individual quanto na comunitaria, instigam o desenvolvimento de estrategias inovadoras que promovam uma autogestao eficaz (1).

Dessa maneira, algumas decisoes no manejo terapeutico impactam na qualidade de vida da pessoa com DM2, pois muitas das complicacoes evoluem para incapacidades. Ademais, o tratamento das complicacoes determina maiores custos, tanto no ambito pessoal como no do sistema de saude (2).

Por isso, as normas de orientacao das organizacoes cientificas dedicadas ao estudo da DM2 orientam a participacao das pessoas em programas de educacao para o autocuidado com o diabetes mellitus (PEADM). Esses programas instruem o individuo de maneira que obtenha conhecimento suficiente para tomar decisoes e, concomitante a isso, induz a autogestao (3). Assim, os PEADM beneficiam e melhoram as condicoes de saude dessa populacao (4).

A autogestao e definida como a capacidade do individuo, junto a familia, a comunidade e aos profissionais de saude, de gerir os sintomas, o tratamento e as alteracoes psicossociais, culturais e espirituais decorrentes de condicoes cronicas. Para tanto, os processos relacionados a autogestao incluem definicao de metas, automonitoramento e pensamento reflexivo, tomada de decisoes, planejamento e engajamento em comportamentos de saude especificos, autoavaliacao e gestao de respostas fisicas, emocionais e cognitivas com relacao a mudanca de comportamento de saude (5).

Uma das formas de apoiar a autogestao e adotar a perspectiva do suporte social. O suporte social constitui uma rede de cuidados provindos de pessoas proximas ou profissionais que atende um individuo, independentemente de ser o local que realiza seu tratamento. Esse suporte gera conhecimento e afeto, o que possibilita a aprendizagem, a seguranca e a melhora da autoestima. Esses sentimientos contribuem para a continuidade das atividades de forma assidua, convergindo para o nao abandono do tratamento e o nao afastamento social do individuo (6).

Aqueles que recebem e, principalmente, percebem o suporte social auferido por sua rede de apoio conseguem enfrentar tais adversidades com mais empenho, devido ao fato de saberem a quem recorrer e de quem receber os auxilios necessarios. Portanto, isso facilita a autogestao no tratamento de uma patologia, ressaltando esse momento por ser um periodo delicado, com adaptacoes e renuncias individuais (7).

Considerando essa perspectiva, as intervencoes pautadas em apoio social sao capazes de modificar condicoes de saude, porque atuam de maneira a diminuir o estresse do individuo no nivel mental e fisico, bem como a reduzir comportamentos maléficos a saude (8).

De acordo com a literatura, a enfermagem se destaca como a profissao mais bem preparada para apoiar a autogestao, ja que a sua importancia esta no fato de fortalecer o vinculo para o tratamento, conhecer e planejar rotinas, a fim de gerenciar uma condicao cronica (9).

Nesse sentido, destacam-se os programas especificos com lideranca de enfermeiros que ofertam apoio social para o ensino de habilidades de autogestao (9). Assim, ha necessidade de conhecer os programas liderados por enfermeiros que visam promover a autogestao por meio do suporte social no campo do DM2, uma vez que, atualmente, ha escassez de informacoes sobre suas caracteristicas. Ademais, compreender o estado atual da arte com relacao a esses programas seria util para informar pesquisas futuras.

Ainda, intervencoes de enfermagem com foco no suporte social para apoiar a autogestao do paciente com DM2 contribuem para o processo saude-doenca de maneira a capacitar o cliente para gerenciar sua condicao de saude. Para tanto, faz-se necessaria a realizacao desta scoping review com a proposta de sintetizar evidencias cientificas atuais sobre a tematica.

Esta revisao tem como objetivo principal mapear a natureza e a extensao da producao cientifica publicada e da literatura cinzenta relacionada a programas liderados por enfermeiros com o intuito de apoiar a autogestao dos cuidados de pessoas com DM2 por meio do suporte social. Apresenta os seguintes objetivos especificos: listar os programas voltados ao suporte social para a pessoa com DM2 liderados por enfermeiros; descrever os conteudos desses programas e identificar os resultados relativos a eles.

Materiais e método

Trata-se de uma revisao de escopo, cuja finalidade e mapear, explorar e descrever a literatura do campo de pesquisa e os limites conceituais do tema abordado.

Para a conducao da revisao de escopo, seguiram-se as orientacoes metodologicas do Joanna Briggs Institute (JBI). Assim, as seguintes etapas foram cumpridas, conforme o Preferred Reporting Items for Systematic review and Meta-Analyses extension for Scoping Reviews (Prisma-ScR) versao 2020: definicao e alinhamento dos objetivos e questoes; desenvolvimento e alinhamento dos criterios de inclusao com o objetivo e a pergunta; descricao da abordagem planejada para busca de evidencias, selecao, extracao de dados e apresentacao das evidencias; busca pelas evidencias; selecao das evidencias; extracao das evidencias; avaliacao das evidencias; apresentacao dos resultados; resumo das evidencias com relacao ao proposito da revisao, estabelecendo conclusoes e observando quaisquer implicacoes das descobertas (10).

Protocolo de registro

Ha um protocolo de elaboracao desta revisao cadastrado na plataforma da Open Science Framework (OSF), podendo ser acessado pelo seguinte link: https://osf.io/4wvt6.

Identificação da questão norteadora

A questao norteadora elaborada foi a seguinte: que programas liderados por enfermeiros existem para apoiar o autogerenciamento das pessoas com DM2 por meio do suporte social e quais as suas caracteristicas?

Ademais, utilizou-se a estrategia mnemonica PCC (populacao, conceito e contexto) para a integracao dos estudos nesta revisao. Portanto, a populacao e de adultos com DM2; o conceito, programas de suporte social liderados por enfermeiros; o contexto, atencao primaria de saude ou comunidade.

Critérios de elegibilidade

Os criterios de elegibilidade adotados foram estudos publicados com o tema proposto em ingles, espanhol e portugues; artigos, teses e dissertacoes completos disponiveis na web; qualquer estudo, independentemente do desenho metodologico (qualitativos, quantitativos e mistos), que explore a experiencia do participante em programas que visam ao suporte a autogestao da DM por meio do suporte social e liderados por enfermeiros; estudos com participantes de 18 anos de idade ou maiores, com diagnostico de DM2, realizados no contexto da atencao primaria de saude e com intervencoes de programas sob lideranca da enfermagem.

Estratégia de busca

A busca pelos estudos foi conduzida nas seguintes bases de dados: Web of Science, Medline (PubMed), Cinahl (EBSCO), Catalogo de Teses e Dissertacoes da Capes, Scopus, JBI Evidence Synthesis, PsycINFO (APA) e Repositorios Cientificos de Acesso Aberto de Portugal.

A pesquisa nessas bases de dados foi realizada entre 23 de fevereiro e 17 de marco de 2022. Posteriormente, as listas de referencias dos estudos incluidos foram pesquisadas manualmente para identificar quaisquer estudos relevantes.

As estrategias de busca para cada base de dados estao na Tabela 1 e foram elaboradas com o auxilio de dois bibliotecarios com expertise na area da saude e em revisoes sistematizadas.

Tabela 1

Estrategias de busca utilizadas nas bases de dados exploradas. Brasil, 2022

Database Search Strategy Search Date Retrieved Articles
Cinahl (EBSCO) ((MM “Self Care”) OR (MM “Self-Management”)) AND (MM “Support, Social/UT”) AND (MM “Community Programs”) AND (MM “Nurses”) AND (MM “Diabetes Mellitus, Type 2”). 17/03/2022 11
Open Access Scientific Repositories of Portugal (RCAAP) “Social support” AND diabetes 17/03/2022 181
Web of Science (“Self Care” OR “self management”) AND (“Social Support” OR “Social Care” OR “Online Social Support” OR “Perceived Social Support” OR “Perceived Social Supports”) AND (“nurse-led education” OR “nurse- delivered intervention” OR “nurse-led intervention” OR “program development” OR “nurse-led program”) AND (“diabetes” OR “diabetes mellitus” OR “diabetes mellitus, Type 2” OR “Diabetes Mellitus, Type II” OR “Type 2 Diabetes Mellitus” OR “Type 2 Diabetes” OR “Diabetes, Type 2”) 23/02/2022 3
Scopus (“Self Care” OR “self management”) AND (“Social Support” OR “Social Care” OR “Online Social Support” OR “Perceived Social Support” OR “Perceived Social Supports”) AND (“nurse-led education” OR “nurse- delivered intervention” OR “nurse-led intervention” OR “program development” OR “nurse-led program”) AND (“diabetes” OR “diabetes mellitus” OR “diabetes mellitus, Type 2” OR “Diabetes Mellitus, Type II” OR “Type 2 Diabetes Mellitus” OR “Type 2 Diabetes” OR “Diabetes, Type 2”). 23/02/2022 24
PsycINFO (“Self Care” OR “self management”) AND (“Social Support” OR “Social Care” OR “Online Social Support” OR “Perceived Social Support” OR “Perceived Social Supports”) AND (“nurse-led education” OR “nurse- delivered intervention” OR “nurse-led intervention” OR “program development” OR “nurse-led program”) AND (“diabetes” OR “diabetes mellitus” OR “diabetes mellitus, Type 2” OR “Diabetes Mellitus, Type II” OR “Type 2 Diabetes Mellitus” OR “Type 2 Diabetes” OR “Diabetes, Type 2”). 23/02/2022 14
JBI Evidence Synthesis Self Care AND Social Support AND nurse led AND diabetes Type 2. 09/03/2022 62
Capes Catalog of Theses and Dissertations “Suporte social” AND “Diabetes” 17/03/2022 1429
PubMed (“Self Care” [MeSH Terms] OR “Self Care” [Text Word] OR “self management” [Text Word]) AND (“Social Support” [MeSH Terms] OR “Social Care” [Text Word] OR “Online Social Support” [Text Word] OR “Perceived Social Support” [Text Word] OR “Perceived Social Supports” [Text Word]) AND (“nurse-led education” [Text Word] OR “nurse-delivered intervention” [All Fields] OR “nurse-led intervention” OR “program development” [All Fields] OR “nurse-led program” [All Fields]) AND (“diabetes” OR “diabetes mellitus” OR “diabetes mellitus, Type 2” OR “Diabetes Mellitus, Type II” OR “Type 2 Diabetes Mellitus” OR “Type 2 Diabetes” OR “Diabetes, Type 2”) 09/03/2022 19

[i]Fonte: dados da pesquisa (2022).

Seleção dos estudos

Apos a busca nas bases de dados, todos os estudos foram exportados para um gerenciador de referencias (EndNote). Realizou-se a remocao dos artigos duplicados com ferramenta de automacao e de forma manual. Destaca-se que os descritores foram adaptados para cada base de dados, por meio de sinonimos, com o intuito de encontrar o maior numero de estudos.

Na sequencia, os titulos e os resumos foram triados a partir dos criterios de inclusao com o apoio da ferramenta Rayyan the Systematic Reviews web/mobile app para que dois autores de forma independente realizassem a triagem de titulo/resumo e texto completo de modo independente e cego. Em caso de duvidas, um terceiro autor realizou a leitura do manuscrito e decidiu pela sua inclusao ou nao. As publicacoes que atendiam aos criterios de elegibilidade foram recuperadas na integra.

Mapeamento dos dados

Um formulario foi construido pela autora para realizar a extracao dos dados. Em seguida, foi realizado um pre-teste para avaliar as necessidades de ajustes. Os dados extraidos incluiram autor, titulo, ano de publicacao, pais do estudo, nome da revista, tipo de documento, idioma, objetivo do estudo, cenario do estudo, metodos, populacao/tamanho da amostra, criterio de inclusao, criterio de exclusao, instrumento/tecnica de coleta, resultados/impactos do programa, conclusoes, caracteristicas sociais dos participantes, caracteristicas clinicas dos participantes, duracao do programa/ intervencao, modelo teorico base, recursos utilizados, implementacao do programa, avaliacao de satisfacao do usuario.

Compilando, resumindo e relatando os resultados

Foi realizada uma analise descritiva das informacoes relacionadas aos programas liderados por enfermeiros e suas caracteristicas. As evidencias foram sintetizadas com base nas questoes de pesquisa. Construiu-se uma tabela com dados alocados aos estudos incluidos na revisao e uma tabela sobre os programas existentes. Adicionalmente, elaborou-se uma figura com o modelo teorico base das intervencoes.

As etapas de busca sao representadas no diagrama de fluxo do Preferred Reporting Items for Systematic Reviews and Metaanalyses (Prisma-ScR), uma extensao para a revisao de escopo.

Resultados

Pesquisa da literatura

Foram identificadas inicialmente 1743 publicacoes, conforme indicado na Figura 1. Apos a remocao de 10 estudos duplicados, realizou-se a triagem dos titulos e resumos, resultando em uma amostra de 12 documentos para a leitura integral.

Figura 1

Processo de identificacao e inclusao dos estudos. Fluxograma Prisma-ScR

1657-5997-aqui-24-01-e2412-gf3.png

Fonte: elaboracao propria.

Posteriormente, sete publicacoes foram excluidas por nao atenderem aos criterios de elegibilidade, deixando-nos com cinco publicacoes elegiveis para a analise. Durante a revisao das referencias dos estudos incluidos, identificou-se a necessidade de incorporar sete documentos adicionais. Dessa maneira, a presente revisao foi composta de 12 estudos, apos a inclusao dos documentos relevantes.

Os estudos selecionados surgiram de modo mais frequente ha mais de cinco anos (n = 8), em paises desenvolvidos como Estados Unidos, Inglaterra e Ira (n = 6), conforme a Tabela 2, que mostra as principais caracteristicas dos estudos incluidos nesta revisao.

Tabela 2

Estudos incluidos na revisao de escopo segundo autor, tipo de estudo, titulo, pais e ano de publicacao. Brasil, 2022

Autor Tipo de estudo Título País Ano de publicação
Klein HA, Jackson SM, Street K, Whitacre JC, Klein G Artigo: revisão sistemática + metanálise Diabetes self-management education: Miles to go Estados Unidos 2012
Pereira DA, Costa NMSC, Sousa ALL, Jardim PCBV, Zanini CRO Artigo: ensaio clínico controlado e randomizado Efeito de intervenção educativa sobre o conhecimento da doença em pacientes com diabetes mellitus Brasil 2012
Parker D, Clifton K, Shams R, Young J Artigo: revisão sistemática The effectiveness of nurse-led care in general practice on clinical outcomes in adults with type 2 diabetes Austrália 2012
Mahdizadeh M, Peyman N, Thagipour A, Esmaily H Artigo: ensaio clínico controlado e randomizado Effect of health education program on promoting physical activity among diabetic women in Mashhad, Iran: Applying social cognitive theory Irã 2013
Bertolin DC Tese: ensaio clínico controlado e randomizado Estresse, modos de enfrentamento e aceitação da doença de pessoas com diabetes mellitus tipo 2 participantes de um programa educativo como envolvimento de um familiar: ensaio clínico randomizado Brasil 2013
Tang PC, Overhag JM, Chan AS, Brown NL, Aghighi B, Entwistle MP et al. Artigo: ensaio clínico controlado e randomizado Online disease management of diabetes: Engaging and motivating patients online with enhanced resources-diabetes (EMPOWER-D), a randomized controlled trial Estados Unidos 2013
Villas Boas LCG, Pace AE Tese: ensaio clínico controlado e randomizado Contribuição do apoio social familiar nos resultados das intervenções educativas junto às pessoas com diabetes mellitus tipo 2: ensaio clínico controlado randomizado Brasil 2014
Gomides DS Dissertação: estudo observacional longitudinal Resultados de intervenções para o cuidado do diabetes mellitus com foco no apoio social: estudo longitudinal Brasil 2016
Murray E, Sweeting M, Dack C, Pal K, Modrow K, Hudda M et al. Artigo: ensaio clínico controlado e randomizado Web-based self-management support for people with type 2 diabetes (HeLP- Diabetes): Randomised controlled trial in English primary care Inglaterra 2017
Golnaz A, Kim LS, Shariff GS, Said S, Sanaz A, Mosayeb M et al. Artigo: ensaio clínico randomizado duplo-cego Effect of a nurse-led diabetes self- management education program on glycosylated hemoglobin among adults with type 2 diabetes Irã 2018
Hadjiconstantinou M Tese: revisão sistemática e metanálise + grupos focais The development of an online emotional support programme, to improve diabetes related distress and well-being in type 2 diabetes Inglaterra 2018
Van Puffelen AL, Rijken M, Heijmans MJWM, Nijpels G, Schellevis Artigo: ensaio clínico randomizado Effectiveness of a self-management support program for type 2 diabetes patients in the first years of illness: Results from a randomized controlled trial Holanda 2019

[i]Fonte: dados da pesquisa (2022).

Com relacao aos desenhos de estudo, houve predominio de ensaios clinicos randomizado (n = 8). Os demais foram revisoes sistematicas mais metanalise (n = 2), revisao sistematica (n = 1) e estudo observacional longitudinal (n = 1). Quanto ao tipo de documento, oito sao artigos, tres sao teses e um e dissertacao.

Características dos estudos

Os programas liderados por enfermeiros foram implementados nos seguintes locais: clinicas de atendimento em geral (n = 6), servico especializado de atendimento as pessoas com doenca cronica (n = 3), hospital universitario (n = 3), como aparece na Tabela 3.

Tabela 3

Programas liderados por enfermeiros com foco no suporte social para pessoas com diabetes do tipo 2 conforme autor, local de intervencao, resultados alcancados e publico assistido

Autor Local de intervenção Resultado da intervenção Público assistido
Klein HA, Jackson SM, Street K, Whitacre JC, Klein G Aleatoriamente atribuídos Redução significativa dos níveis de hemoglobina glicada no sangue. Idade (média): ND Sexo: ND Escolaridade: ND
Pereira DA, Costa NMSC, Sousa ALL, Jardim PCBV, Zanini CRO Serviço de referência para tratamento da hipertensão arterial Aumento do nível de conhecimento sobre diabetes mellitus. Idade (média): 65,8 anos Sexo: feminino Escolaridade: 8 anos de estudo
Parker D, Clifton K, Shams R, Young J Ambiente de clínica geral/familiar Melhora dos níveis clínicos: alterações na pressão arterial (PA) sistólica e diastólica, índice de massa corporal (IMC), níveis de colesterol, HbA1c (hemoglobina glicada) e glicemia de jejum. Idade: >18a Sexo: ND Escolaridade: ND
Mahdizadeh M, Peyman N, Thagipour A, Esmaily H Centros de saúde em Mash had City, leste do Irã No grupo de intervenção (GI), a atividade física leve e o comportamento sedentário reduziram de 56,1 % (23 indivíduos) para 14,6 % (6 indivíduos) na etapa seguinte. Melhora significativa ao longo do tempo na prática de atividade física (aumento na média de minutos praticados por semana). A adesão à prática de atividade física foi maior nos grupos devido ao apoio social recebido, principalmente por familiares, amigos e parceiros de exercícios. Idade (média): 48,37 anos Sexo: feminino Escolaridade: ND
Bertolin DC Ambulatório de diabetes em unidade de hospital universitário de nível terciário de atenção à saúde Modos de enfrentamentos mais referidos: reestruturação cognitiva, procura de informações; aceitação mediana da doença; baixa percepção de estresse; algum grau de estresse (na fase de resistência da doença). Idade (média): 60,4 anos Sexo: feminino Escolaridade: mínimo 0 e máximo 17 anos de estudo
Tang PC, Overhag JM, Chan AS, Brown NL, Aghighi B, Entwistle MP et al. Fundação Médica de Palo Alto, uma organização de saúde sem fins lucrativos O GI teve controle significativamente melhor do Diabetes do que o grupo controle (GC), nos 6 primeiros meses. Não havendo diferença significativa após 12 meses. O GI teve controle significativamente melhor do colesterol LDL, aos 12 meses. Não houve diferença estatisticamente significativa para controle da PA, peso e risco de Framingham, aos 12 meses. Idade: > 18 anos Sexo: masculino Escolaridade: > 12 anos de estudo
Villas Boas LCG, Pace AE Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP) Não houve diferença estatística significativa após as intervenções para percepção de autoeficácia, conhecimento sobre diabetes, adesão ao medicamento e percepção de apoio social. Para a variável de autocuidado, o GC apresentou melhor desempenho do que o GI, em um comportamento relacionado à alimentação e em dois relacionados à atividade física. Referente às variáveis clínicas, o GC apresentou menor índice de massa corporal e menor circunferência abdominal entre as mulheres. Controle metabólico: não houve diferença estatisticamente significante, mas houve uma redução da hemoglobina glicada a favor do grupo intervenção. Idade (média): 60,43 anos Sexo: feminino Escolaridade: < 9 anos
Gomides DS Ambulatório de diabetes de um hospital de nível de atenção terciária Não houve diferença entre os grupos para as variáveis PA, circunferência abdominal, IMC, hemoglobina glicada, glicemia plasmática de jejum, atividades de autocuidado, conhecimento sobre a doença e autoeficácia. O período foi definido em basal, fim das intervenções e 24 meses após as intervenções. Ao comparar os tempos, houve redução da PA e hemoglobina glicada, aumento do IMC e circunferência abdominal, em ambos os grupos. Conhecimento e atividades de autocuidado aumentaram imediatamente após as intervenções e diminuíram após dois anos, em ambos os grupos. Autoeficácia se manteve no GI e se reduziu no GC, após dois anos e ao término das intervenções. Intervenções incluindo apoio social não mostraram diferença entre os grupos e no decorrer do tempo e, mediante análise descritiva, houve melhora na autoeficácia, que se manteve após dois anos, no GI. Intervenções educativas grupais foram efetivas na melhora do controle glicêmico e da PA dois anos após as intervenções. Para as variáveis conhecimento sobre a doença e autocuidado, os resultados sugerem necessidade de reforços educativos, no decorrer do tempo. Idade: entre 45 e 84 Sexo: feminino Escolaridade: entre 0 e 17 anos de estudo
Murray E, Sweeting M, Dack C, Pal K, Modrow K, Hudda M et al. 21 clínicas gerais na Inglaterra com uma mistura de práticas urbanas, suburbanas e rurais Os participantes do GI apresentaram menor hemoglobina glicada (HbA1c) do que os do GC. Não houve diferença global significativa entre os grupos no escore estresse relacionado ao diabetes, medido pela escala áreas de problema em diabetes. Entretanto, para os participantes que foram diagnosticados com diabetes mais recentemente, mostrou um impacto benéfico da intervenção nesse grupo. Idade: 65 anos Sexo: masculino Escolaridade: ND
Golnaz A, Kim LS, Shariff GS, Said S, Sanaz A, Mosayeb M et al. Ambulatório de endócrino primário e secundário urbano localizado em um hospital universitário na cidade de Ilam, Irã Os pacientes do GI apresentaram melhora significativa na hemoglobina glicada, na PA, no peso corporal, na expectativa de eficácia, na expectativa de resultado e nos comportamentos de autogestão do diabetes. Idade (média): 54,2 ± 11,8 anos (variação de 22 a 69 anos) Sexo: feminino Escolaridade: 9 anos de estudo
Hadjiconstantinou M Leicester Diabetes Centre O suporte on-line liderado por profissionais foi associado a resultados positivos