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Introduction Type 2 diabetes mellitus (T2DM) has is one of the most common chronic metabolic disorders worldwide, characterized by insulin resistance and an inability to maintain normal glucose levels. The effective management of T2DM is multifaceted, requiring not only medical treatment but also lifestyle modifications to help with maintaining adequate glycemic control. Diabetes self-management education (DSME) programs have been implemented to provide patients with the necessary knowledge and skills in order to take responsibility for their own diabetes care (Ji et al., 2020). Despite the availability of these educational resources, many patients are still struggling with adherence to treatment practices, resulting in inadequate glycemic control and an increasing burden of complications, both microvascular and macrovascular, leading to higher healthcare costs and reduced quality of life (He et al., 2022). This situation underscores the necessity of investigating the impact of DSME programs on treatment adherence. The rising prevalence of T2DM, along with its associated complications like cardiovascular disease, nephropathy, and retinopathy, requires more research on the factors that contribute to treatment non-adherence. It is common that patients experience barriers to effective self-management due to gaps in health literacy, lack of understanding related to diabetes management, and inadequate support systems (Timsina et al., 2022). Moreover, sociocultural factors can further complicate self-care practices, most commonly within immigrant populations who often face unique challenges due to lack of resources and cultural practices (Timsina et al., 2022). Therefore, the research question for this literature review is: In adults with type 2 diabetes (P), how does participating in diabetes self-management education programs (I) compared to not participating (C) influence treatment adherence (O)? This paper will explore the current literature regarding the relationship between DSME programs and treatment adherence, emphasizing the need for tailored educational interventions, periodic assessments, and the role of social support networks. Evidence from recent studies will be included to provide recommendations aimed at enhancing the effectiveness of DSME programs in promoting treatment adherence among individuals with T2DM. Body To evaluate the impact of DSME programs on treatment adherence, a systematic literature review was conducted using the CINAHL database. A thorough search utilizing the keywords "diabetes AND self-management education AND adherence" yielded an initial amount of 16, articles. Filters were applied to limit the range to publications that were peer-reviewed, had full- text availability, and were published between 2020 and 2025. This filtering resulted in 345 relevant articles, which were further narrowed down to 18 studies focusing specifically on nursing-related publications that addressed the impact of education programs on treatment adherence in adults with T2DM. The inclusion criteria for this review comprised of studies that had educational interventions designed for adults with T2DM while focusing on their direct implications for treatment adherence. The literature review was consistently showing a positive correlation between participation in DSME programs and increased adherence to prescribed diabetes management protocols. For instance, research indicates that individuals who engage in educational interventions have improved understanding of their condition, which can foster higher levels of self-efficacy. This greater self-efficacy is reflected in their commitment to adhere to medication
regimens and lifestyle modifications necessary for effective diabetes management (Cha et al., 2024). In addition to improved self-efficacy, the need for continuous education has emerged as a critical factor related to adherence. Participants across various studies reported the necessity for refresher courses or additional educational supportāeven after years of managing their condition. Therefore, this finding is consistent with the idea that diabetes management is not a one-time educational intervention but rather a continuous learning process that adapts to continuously changing health care and treatment needs (Despins & Wakefield, 2020). Regularly scheduled reassessments can also aid as reinforcements to knowledge and compliance, allowing providers to identify gaps in knowledge or areas of concern that may hinder effective self- management. While there are many advantages of DSME programs, barriers to participation must also be recognized. For example, limited access to educational resources in underserved populations, poses risks to treatment adherence. For instance, studies focusing on Bhutanese refugees have shown that limited English proficiency and low health literacy levels negatively impact their understanding of diabetes and adherence to treatment regimens (Timsina et al., 2022). These barriers highlight the importance of culturally competent interventions designed to increase accessibility to DSME programs and improve health outcomes. Moreover, the role of social support networks in influencing treatment adherence cannot be overemphasized. In addition, individuals with T2DM often benefit from the support and encouragement from family and friends. Research indicates that strong social support systems improve self-management behaviors and outcomes (Timsina et al., 2022). Healthcare providers should also prioritize creating a supportive environment by including family members in educational sessions and promoting peer support groups that allow patients to share experiences and strategies for successful diabetes management (Timsina et al., 2022). To further elaborate on the benefits of DSME programs and their effects of treatment adherence, patterns and themes derived from research will guide evidence-based recommendations. Some strategies for improving DSME effectiveness include developing tailored educational interventions suitable for patientsā cultural considerations and varying health literacy levels. Customizing educational approaches ensures that the content is applicable and clear, potentially increasing engagement and adherence. In addition to tailoring such educational content, integrating routine evaluations to the diabetes care plan can enhance understanding and reinforce patient self-monitoring skills and education. These assessments can offer opportunities for patients to clarify misunderstandings, address questions, and receive feedback from healthcare providers, promoting a collaborative approach to diabetes management. By fostering therapeutic relationships and using open communication, healthcare professionals can help patients navigate their self-management journeys. Furthermore, incorporating family involvement into DSME initiatives is vital. Including patients family members to care plans can enhance the supportive environment necessary for the patientās adherence to treatment protocols. Involving peers who have successfully managed their diabetes in educational programs can also provide motivation and establish a community of shared experiences. Such groups can create positive outcomes by promoting accountability and encouraging discussions around challenges and successes in managing diabetes. Implementing health information technologies is another essential way for improving treatment adherence. The utilization of mobile applications or electronic health tools that help
advocating for insurance companies to expand coverage of CGM and insulin pumps is essential to ensure equitable access. Employing empowerment theory can also guide nursing interventions, equipping Black older adults with the tools needed to manage their diabetes effectively. In summary, addressing the barriers and facilitators of CGM use among Black older adults necessitates a comprehensive approach that prioritizes education, support, and empowerment, with nurses playing a pivotal role in enhancing the adoption of CGM and improving health outcomes within this population (Owusu et al., 2024). Conclusion In conclusion, DSME programs play a critical role in enhancing treatment adherence among adults with Type 2 diabetes. Research highlights the importance of tailored educational interventions, intermittent reassessments, and the inclusion of social support networks in promoting adherence to diabetes management protocols. By focusing on culturally competent approaches, health professionals can effectively engage patients in their care, helping to overcome barriers to treatment adherence. The continuous growth of diabetes education in self-management behaviors calls for ongoing commitment to education and support, ensuring that patients remain well-informed and have the support to navigate their health journeys effectively. As the global prevalence of T2DM continues to rise, further research and innovative strategies are required to refine DSME programs and enhance their effectiveness in improving treatment adherence. Ultimately, fostering a supportive and collaborative environment for individuals with diabetes not only can optimize patient health outcomes, but also contribute to the reducing of overall burden of this chronic disease on healthcare systems.
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