Background: Diabetes is a chronic global health issue that requires effective management to improve patient outcomes and quality of life. Nursing education plays a critical role in empowering diabetic patients with self-management skills. Aim This systematic review evaluates the impact of diabetes-focused nursing education on patient outcomes and quality of life. Methods: This study uses PRISMA guidelines and a systematic approach to identify and evaluate relevant literature. Results and Discussion: Among the 14 studies reviewed, eight emphasized self-management education, while four incorporated multidisciplinary approaches. Findings consistently demonstrated that structured nursing education programs significantly improved self-management behaviors, glycemic control, and patient knowledge. For instance, nurse-led self-management programs resulted in substantial enhancements in self-care skills and diabetes-related knowledge. Moreover, interventions that combined health education with psychological support were particularly effective, leading to better blood glucose control and increased adherence to treatment. Studies that examined quality of life reported reductions in anxiety, improved lifestyle habits, and better overall self-management. These findings highlight the multifaceted benefits of nursing education, suggesting that structured, supportive programs positively impact both clinical and psychological aspects of diabetes care. Conclusion: The review emphasizes the value of comprehensive nursing education that integrates both clinical guidance and psychological support for holistic diabetes management. Implications: Ongoing professional development and culturally sensitive education programs are recommended to address the diverse needs of diabetic patients. Future research should investigate the long-term effects of nursing education and explore innovative strategies to enhance diabetes management outcomes.

What is Known on the Topic

1. Diabetes is a global health issue, with rising prevalence and significant complications affecting quality of life.
2. Nursing education plays a crucial role in improving diabetes self-management and patient outcomes.
3. Tailored education programs improve glycemic control, reduce complications, and enhance patients' quality of life.

What This Paper Adds

1. Structured nursing education programs improve self-management behaviors, glycemic control, and emotional well-being.
2. Multifaceted interventions, including psychological support, enhance both clinical outcomes and quality of life.
3. Diverse approaches, such as culturally sensitive and multidisciplinary programs, address the unique needs of diabetic patients.

Diabetes is a chronic condition characterized by the body's inability to produce enough insulin or to use insulin effectively. Diabetes encompasses a range of metabolic disorders marked by chronic hyperglycemia due to defects in insulin secretion, insulin action, or both, leading to microvascular complications affecting the eyes, kidneys, and nerves, and macrovascular complications such as heart disease and stroke [1]. It has several types that present as health challenge for many individuals in the world. Type 1 diabetes is an autoimmune condition, often diagnosed in childhood, where the immune system attacks insulin-producing cells in the pancreas. Type 2 diabetes, the most common form, results from a combination of insulin resistance and relative insulin deficiency, frequently associated with obesity and a sedentary lifestyle. Gestational diabetes occurs during pregnancy and increases the risk of developing Type 2 diabetes later in life. Other specific types of diabetes can result from genetic mutations, endocrine disorders, or drug-induced conditions. [2, 1] In terms of prevalence, diabetes is a global concern. The global prevalence of diabetes is highest in the Middle East and North Africa (MENA) region, with a comparative prevalence of 18.1%, while the lowest is in the Africa (AFR) region at 5.3%. The Western Pacific region, which includes the Philippines, has the largest number of people with diabetes, estimated at 206 million. The number of people with diabetes is expected to grow the most in the MENA and AFR regions by 2045 due to factors such as population growth, aging, and urbanization [3]. Globally, diabetes-related health expenditures are substantial, amounting to 966 billion USD in 2021 and projected to exceed one trillion USD by 2045 [3].

In the Philippines, an estimated 4.3 million Filipinos were diagnosed with diabetes, while approximately 2.8 million remained undiagnosed, indicating that 1 in 14 Filipino adults has diabetes. The prevalence of diabetes in the Philippines has been increasing, and this trend is expected to continue. By 2045, the number of Filipinos with diabetes is projected to reach 7.5 million, highlighting the urgent need for enhanced management and prevention strategies [4]. This increasing prevalence mirrors the global trend, where the prevalence of diabetes among adults aged 20-79 is estimated to be 10.5%, translating to approximately 536.6 million individuals in 2021, with projections suggesting a rise to around 783.2 million by 2045 [3].

It also significantly impacts mortality in the Philippines, ranking as the fourth leading cause of death in 2022, with 26,744 diabetes-related deaths, accounting for 6.4% of total deaths [4]. The increasing prevalence and mortality associated with diabetes necessitate healthcare interventions and policies to manage and mitigate the disease's impact on the Filipino population. In this regard, nursing education plays a crucial role in promoting the self-management of diabetes.

[5] notes that nursing education equips individuals with the skills and knowledge necessary to manage their condition effectively, including monitoring blood glucose levels, administering insulin, and making appropriate dietary and lifestyle choices. Nurses utilize various educational interventions, such as motivational interviewing and therapeutic play, to enhance adolescents' ability to manage their diabetes. These interventions have demonstrated improvements in health outcomes, including better glycemic control, reduced hospitalization rates, and an overall enhancement in the quality of life for these young patients [5].

In hospital settings, nursing education significantly impacts the management of diabetes by enhancing the knowledge and skills of nursing staff. Structured educational programs, both online and face-to-face, improve nurses' competence and confidence in managing diabetic patients. These programs cover essential aspects such as glucose monitoring, insulin administration, and patient education. Nurses who participate in these educational interventions demonstrate better management of blood glucose levels and appropriate treatment of hypoglycemia, leading to improved patient outcomes [6, 5].

Against this, there is benefit in understanding the impact of diabetes nursing education on the quality of life of people with diabetes, especially as the growing prevalence of diabetes and the need for specialized nursing education. Hence, this systematic review focuses on the determination of the effectiveness of diabetes nursing education programs. Specifically, it aims to determine how nursing education improves patient outcomes as well as determining the role of nursing education in improving the quality of life of diabetic patients through reviewed literature and studies.

The PRISMA flow diagram (Figure 1) illustrates the systematic process guided to evaluate the impact of nursing education on diabetes management and quality of life. Initially, 210 articles were identified using Boolean logic and keywords such as “diabetes AND nursing education,” “nursing education AND diabetes outcomes,” and “nursing education AND quality of life AND diabetes” from databases including PubMed, Scopus, Wiley, ScienceDirect, and Elsevier. Abstract screening narrowed the pool to 100 articles, and 50 full-text studies were further assessed for relevance. Following this detailed review process, 14 studies were ultimately included, highlighting the rigorous and transparent approach undertaken.

In the eligibility stage, the remaining 18 articles were evaluated against specific inclusion criteria. The Population included diabetic patients of all ages and backgrounds to ensure a broad understanding across demographics, excluding studies unrelated to diabetic populations. The Intervention criterion required a focus on nursing education programs designed specifically for diabetes management, excluding general nursing education studies. The Outcomes needed to address glycemic control, self-management, or quality of life, while studies without these metrics were excluded. Finally, Study Characteristics required articles to be peer-reviewed, clinical trials, or longitudinal studies published from 2019 onward. Non-peer-reviewed articles, inaccessible full texts, and irrelevant studies were excluded to ensure high-quality evidence. This process resulted in the selection of 14 robust studies for the systematic review.

Figure 1

PRISMA Flow Diagram

The summary of the study characteristics, as outlined in Table 2, provides a comprehensive overview of the various research designs, objectives, and types of diabetes assessed in recent studies on diabetes nursing education.

The studies predominantly employed quantitative research methods, with 11 out of the 14 studies utilizing this approach. These included pilot studies, quasi- experimental designs, cross-sectional surveys, and randomized controlled trials. One study utilized a mixed-methods approach, integrating both qualitative and quantitative data. The remaining two studies used qualitative methods, specifically semi-structured interviews. The majority of studies focused on Type 2 diabetes, with 10 out of 14 addressing this common form of the disease. Two studies encompassed both Type 1 and Type 2 diabetes. One study examined gestational diabetes, while another focused on diabetic kidney disease. The studies span from 2019 to 2024 with the distribution is as follows: two studies in 2019, four studies in 2021, five studies in 2022, two studies in 2023, and one study in 2024.

3.1. The Role of Nursing Education in Patient Outcomes Improvement for Diabetic Patients

Table 3 presents a detailed examination of various studies that focus on the impact of nursing education on diabetes management and patient outcomes. The table outlines the specific nursing education interventions and their reported effects on diabetic patients, highlighting the diverse approaches and their effectiveness in improving diabetes-related health outcomes.

Most interventions focus on improving self-management behaviors, glycemic control, and patient knowledge. Specific approaches include health education competence [7], diabetes education during dialysis sessions [8], and nurse-led self-management programs [9, 10].

Out of the 14 studies listed, a significant number—eight (57%)—emphasize self- management education as a core component of nursing interventions. These studies consistently report positive outcomes, such as improved self-care knowledge and behaviors [10], better engagement with diabetes care [8], and enhanced self-management skills [9]. This focus on self- management underscores the importance of empowering patients to take active roles in managing their diabetes.

Additionally, four studies (29%) incorporated a multidisciplinary approach, combining nursing education with other forms of healthcare support, such as personalized psychological interventions [11], systematic diet education [12], and therapeutic education programs [13]. These interventions often resulted in improved nutritional status, better metabolic control, and reduced anxiety, highlighting the benefits of comprehensive, multifaceted care.

Table 3 reveals that out of the 14 studies reviewed, six (43%) explicitly discuss the impact of nursing education on the quality of life for diabetic patients. These studies emphasize various aspects such as enhanced self-management, psychological support, and improved lifestyle and adherence to care.

For instance, [8] and [9]) report significant improvements in patient self-management and overall quality of life, with [9]. highlighting the role of family support and culturally tailored education. Similarly, [11] and [13] note enhancements in self-management abilities, reduced anxiety, and better pregnancy outcomes, with a notable percentage of patients acknowledging the essential role of diabetes specialist nurses (DSNs) in managing their condition.

While [14] and [15] also indicate improvements in quality of life through better disease management and enhanced self- efficacy, they do not explicitly quantify these outcomes. Instead, they focus on the educational and support aspects that indirectly contribute to an improved quality of life.

The remaining studies (57%) do not explicitly mention quality of life but imply potential benefits through improved patient compliance, better disease management, and increased satisfaction and engagement with healthcare workers. For example, [16] suggest that graduates' increased confidence and empathy could positively impact patient quality of life, while [17] imply that better disease management could enhance overall well-being.

3.2. The Role of Nursing Education in Quality-of-Life Improvement for Diabetic Patients

Table 4 presents a detailed analysis of various studies that explore the impact of nursing education on the quality of life for diabetic patients. The table highlights the specific roles that nursing education plays in enhancing patient outcomes, with a particular focus on self-management, psychological support, and overall lifestyle improvements.

Results overall illustrates the broad scope of nursing education interventions and their significant roles in enhancing diabetes management. [7] emphasize the importance of health education competence, revealing that while diabetes specialist nurses possess considerable knowledge and skills, there is a need for improvement in educational skills. [8] shows that diabetes education during dialysis, coupled with intermittent continuous glucose monitoring, leads to improved glycemic control and better patient engagement.

[9] and [10] both focus on nurse-led self- management education programs, reporting substantial improvements in self- management behaviors and diabetes-related skills. These findings underscore the efficacy of structured educational interventions in fostering self-care among diabetic patients. [11] and [17] further demonstrate the benefits of combining health education with personalized psychological interventions, resulting in better blood glucose control, increased compliance, and enhanced disease awareness.

Other studies, such as those by [12] and [13], highlight the advantages of multidisciplinary approaches and therapeutic education programs, respectively, which lead to improved nutritional status, better metabolic control, and reduced hypoglycemia episodes. The inclusion of technology, as seen in [18], with online education programs for insulin therapy, also shows positive outcomes in terms of blood glucose control and compliance rates.

The consistent improvement in glycemic control, self-management behaviors, and patient knowledge across various studies underscores the crucial role that well-structured nursing education plays in effective diabetes care. The integration of psychological support within educational programs, as noted in studies by [11] and [17], highlights the importance of addressing the emotional and mental well-being of patients alongside clinical management.

Furthermore, the diverse range of educational approaches—from face-to-face interventions and continuous education to online programs and multidisciplinary strategies—reflects the adaptability and comprehensive nature of nursing education. This adaptability is vital for meeting the unique needs of different patient populations, as evidenced by the positive outcomes reported across various types of diabetes, including Type 2 diabetes, gestational diabetes, and diabetic kidney disease.

Meanwhile, the data from Table 3 highlights the crucial role of nursing education in enhancing the quality of life for diabetic patients. The studies that explicitly mention quality of life improvements consistently report positive outcomes such as better self- management, reduced anxiety, and improved lifestyle adherence. These findings underscore the multifaceted benefits of nursing education, which not only addresses clinical aspects of diabetes care but also supports the psychological and emotional well- being of patients. The focus on self-management education, as seen in studies like [9] and [13], indicates that empowering patients with the knowledge and skills to manage their condition is a key factor in improving their quality of life. This empowerment is further enhanced by personalized psychological support, which addresses the emotional challenges associated with diabetes management.

Moreover, the studies imply that continuous support and culturally tailored education play significant roles in maintaining health behaviors and improving patient outcomes. The importance of diabetes specialist nurses in providing this ongoing support is evident, with patients recognizing their critical role in managing their condition effectively.

To improve diabetes nursing education, it is essential to incorporate continuous professional development programs that focus on enhancing educational skills and competencies. Integrating technology, such as online education platforms and mobile health applications, can provide scalable and accessible educational resources for both patients and healthcare providers. Additionally, developing culturally sensitive and personalized education programs can better address the diverse needs of diabetic patients, leading to improved engagement and outcomes.

In clinical practice, there should be a stronger emphasis on multidisciplinary approaches that combine nursing education with other healthcare supports, such as psychological counseling and nutritional guidance. Implementing regular follow-ups and support sessions can help maintain patient engagement and adherence to self- management practices. Future research should focus on longitudinal studies to evaluate the long-term impact of nursing education on patient outcomes and quality of life. Exploring innovative educational strategies and their integration into routine clinical practice can provide deeper insights into effective diabetes management.

The systematic review underscores the pivotal role of nursing education in enhancing diabetes management and improving the quality of life for diabetic patients. The findings consistently indicate that structured nursing education programs lead to significant improvements in self-management behaviors, glycemic control, and patient knowledge. Studies highlighted the importance of multidisciplinary approaches and personalized psychological support, which not only improve clinical outcomes but also address the emotional and mental well-being of patients. The consistent positive outcomes across various types of diabetes demonstrate the adaptability and effectiveness of nursing education interventions in diverse patient populations.

The review also reveals that while many studies focus on clinical outcomes, the impact of nursing education on the quality of life is equally critical. Enhanced self- management, reduced anxiety, and improved lifestyle adherence are key benefits that contribute to a better quality of life for diabetic patients. These findings highlight the necessity for ongoing, comprehensive nursing education that integrates both clinical and psychological support to foster holistic diabetes care. The role of diabetes specialist nurses in providing continuous support and culturally tailored education is crucial in achieving these outcomes.

Conflicts of Interest: The authors declare that no significant competing financial, professional, or personal interests might have influenced the performance or presentation of the work described in this manuscript.

Funding: No funding for this study.

Acknowledgments: The authors thank Roison Andro Narvaez for imparting us knowledge. St. Paul University Philippines, National University Manila, and Trinity University of Asia for supporting us in our research work.

Author Contributions: CMTC, MVA, MCP, MCH, VDP: Conceptualization, Formal analysis, Investigation, Data curation, Writing – original draft, Project administration. CRTM, RMDJ, DBB: Methodology, Conceptualization, Formal analysis, Investigation, Supervision, Validation, Visualization, Writing – review & editing.

Ethical Consideration: Not Applicable