Optimizing Nursing Care for Patients with Type 2 Diabetes in Primary Health Care through Improving Therapeutic Adherence

Abstract

Background: Type 2 diabetes mellitus (T2DM) remains one of the leading chronic non-communicable diseases worldwide and poses a substantial challenge to healthcare systems because of its increasing prevalence, high risk of chronic complications, and considerable socioeconomic burden. Although advances in pharmacological treatment have significantly improved diabetes management, inadequate therapeutic adherence continues to compromise glycemic control, accelerate disease progression, and increase healthcare utilization. Contemporary international guidelines increasingly recognize that sustainable improvements in adherence require person-centered, multidisciplinary care in which nurses play a central role in diabetes self-management education, behavioral counseling, and continuity of care within primary health care (PHC).
Objective: To synthesize current evidence regarding nursing interventions that improve therapeutic adherence among adults with T2DM in PHC and to propose a conceptual framework for optimizing nursing care as the theoretical foundation for an ongoing master's research project.
Methods: This conceptual paper integrates evidence from contemporary international clinical guidelines, consensus statements, systematic reviews, and meta-analyses published by leading organizations, including the World Health Organization (WHO), the International Diabetes Federation (IDF), the American Diabetes Association (ADA), and other evidence-based sources. The synthesized evidence was used to develop a conceptual framework describing evidence-based nursing strategies aimed at strengthening therapeutic adherence among adults with T2DM in PHC settings.
Results: The synthesized evidence demonstrates that structured nurse-led interventions—including comprehensive adherence assessment, diabetes self-management education and support, motivational interviewing, individualized behavioral counseling, psychosocial support, digital health technologies, and continuous follow-up—consistently improve medication adherence, self-management behaviors, glycated hemoglobin (HbA1c), patient engagement, and health-related quality of life. Based on these findings, a comprehensive conceptual framework for optimizing nursing care was developed, integrating assessment, individualized education, behavioral support, continuity of care, and outcome evaluation into a structured model applicable to routine PHC practice.
Conclusion: Optimizing nursing care through evidence-based, adherence-focused interventions represents a promising strategy for improving therapeutic adherence and strengthening person-centered diabetes management within primary health care. The proposed conceptual framework translates contemporary international recommendations into a structured nursing model that may facilitate implementation of evidence-based practice, improve continuity of care, and support future clinical research evaluating its effectiveness in patients with T2DM.