Translational nursing: a systematic review of behavioral determinants and glycemic control in adults with type 2 diabetes
Main Article Content
Keywords
Diabetes Mellitus, Type 2, Health Literacy, Self Efficacy, Self Care, Translational Nursing
Abstract
Introduction: Type 2 diabetes (T2D) is a priority challenge due to its prevalence and the consequences of uncontrolled blood glucose. Within the framework of translational nursing, behavioral determinants play a central role in modulating metabolic outcomes.
Objective: To analyze the relationship of health literacy, self-efficacy, and self-care with glycemic control (HbA1c) in adults with type 2 diabetes.
Methodology: A systematic review was conducted following PRISMA 2020 guidelines. Cohort studies and randomized clinical trials addressing health literacy, self-efficacy, and self-care—and their relationship with glycemic control (HbA1c)—were included. Traceability and critical evidence matrices were integrated, systematizing the metrics reported by each study without recalculating them.
Results: Health literacy showed the least consistent association with glycemic control. Self-efficacy was more consistently associated with improvements in HbA1c. Self-care showed significant associations in the majority of studies, though results were inconsistent in a subset of trials.
Conclusion: Self-efficacy and self-care demonstrated the most consistent associations with glycemic control, whereas health literacy yielded more heterogeneous results. These findings support translational nursing as a strategic axis for transforming this evidence into high-impact clinical interventions.
References
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Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453-7. doi:10.1016/S0140-6736(07)61602-X
Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ.
2010;340:c332. doi:10.1136/bmj.c332
Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Scheckel R, et al. Systematic reviews of etiology and risk. In: Aromataris E, Munn Z,
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Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes selfcare activities measure: results from 7 studies and a revised scale.
Diabetes Care. 2000;23(7):943-50. doi:10.2337/diacare.23.7.943
Van der Bijl JJ, van Poelgeest-Eeltink A, Shortridge-Baggett L. The psychometric properties of diabetes management self-efficacy
scale for patients with type 2 diabetes mellitus. J Adv Nurs. 1999;30 (2):352-9. doi:10.1046/j.1365-2648.1999.01124.x
Anderson RM, Funnell MM, Fitzgerald JT, Marrero DG. The Diabetes Empowerment Scale: a measure of psychosocial self-efficacy. Diabetes Care. 2000;23(6):739-43. doi:10.2337/diacare.23.6.739
Fadli F, Nursalam N, Sjattar EL, Uly N. Improving self-care, HbA1c control, and quality of life in type 2 diabetes: a self-regulation intervention based on the individual and family self-management theory. Front Clin Diabetes Healthc. 2026;6:1712334. doi:10.3389/fcdhc.2025.1712334
Wang X, Tian B, Zhang S, Zhang J, Yang W, Li J, et al. Diabetes knowledge predicts HbA1c levels of people with type 2 diabetes mellitus in rural China: a ten-month follow-up study. Sci Rep. 2023;13: 18248. doi:10.1038/s41598-023-45312-y
Trief PM, Wen H, Burke B, Uschner D, Anderson BJ, Liu X, et al. Psychosocial Factors and Glycemic Control in Young Adults With Youth Onset Type 2 Diabetes. JAMA Netw Open. 2024;7(4):e245620. doi:10.1001/jamanetworkopen.2024.5620
Gao Y, Xiao J, Han Y, Ji J, Jin H, Mawen DG, et al. Self-efficacy mediates the associations of diabetes distress and depressive symptoms with type 2 diabetes management and glycemic control. Gen Hosp Psychiatry. 2022;78:87-95. doi:10.1016/j.genhosppsych.2022.06.003
Gucciardi E, Xu C, Vitale M, Lou W, Horodezny S, Dorado L, et al. Evaluating the impact of onsite diabetes education teams in primary care on clinical outcomes. BMC Fam Pract. 2020;21:48. doi:10.1186/2875-020-01111-2
Ağralı H, Akyar İ. The effect of health literacy-based, health beliefconstructed education on glycated hemoglobin (HbA1c) in people
with type 2 diabetes: A randomized controlled study. Prim Care Diabetes. 2022;16(1):173-8. doi:10.1016/j.pcd.2021.12.010
Sriklo M, Tamdee D, Aungwattana S, Kaewthummanukul T. Effects of Enhance Health Literacy through Transformative Learning Program on Self-Management and Hemoglobin A1C Level Among Adults with Uncontrolled Type 2 Diabetes: A Randomized Controlled Trial. Pac Rim Int J Nurs Res. 2023;27(2):317-33. doi:10.60099/prijnr.2023. 262041
Curtis LM, Davis TC, Arnold CL, Gan JM, McSweeney JC, Hur S, et al. Effectiveness of a health literacy intervention to improve diabetes outcomes in rural family medicine clinics: a randomized pragmatic trial. Health Lit Commun Open. 2024;2(1):2382133. doi:10.1080/2
8355245.2024.2382133
Wang L, Fang H, Xia Q, Liu X, Chen Y, Zhou P, et al. Health literacy and exercise-focused interventions on clinical measurements in Chinese diabetes patients: A cluster randomized controlled trial. EClinicalMedicine. 2019;17:100211. doi:10.1016/j.eclinm.2019.11.004.
Ibrahim NF, Nofal HA, Ali HT, El-Rafey DS, Almadani N, Mahfouz R, et al. Enhancing self-care management in diabetic patients: a randomized controlled trial exploring the interplay of social support, self-efficacy, and empowerment. Acta Diabetol. 2025;62:1691-701. doi:10.1007/s00592-025-02498-z
Ranjbaran S, Shojaeizadeh D, Dehdari T, Yaseri M, Shakibazadeh E. The effectiveness of an intervention designed based on health action process approach on diet and medication adherence among patients with type 2 diabetes: a randomized controlled trial. Diabetol Metab Syndr. 2022;14:3. doi:10.1186/s13098-021-00773-x
Zhang A, Wang J, Wan X, Zhang Z, Zhao S, Bai S, et al. Community-Based Intelligent Blood Glucose Management for Older Adults With Type 2 Diabetes Based on the Health Belief Model: Randomized Controlled Trial. JMIR Mhealth Uhealth. 2025;13:e60227. doi:10.2196/60227
Association of Diabetes Care and Education Specialists, Kolb L. An Effective Model of Diabetes Care and Education: The ADCES7 Self Care Behaviors. Sci Diabetes Self Manag Care. 2021;47(1):30-53. doi:10.1177/0145721720978154
Ibrahim AM, Gano FAEL, Abdel-Aziz HR, Elneblawi NH, Zaghamir DEF, Abu Negm LMM, et al. Tailoring nursing interventions to em
power patients: personal coping strategies and self-management in type 2 diabetes care. BMC Nurs. 2024;23:926. doi:10.1186/s12912-024-02573-w.
Sidani S, Braden CJ. Design, Evaluation, and Translation of Nursing Interventions. 1st ed. Hoboken: Wiley-Blackwell; 2011. doi:10.1002/9781118785553
Pearson A, Jordan Z, Munn Z. Translational Science and Evidence Based Healthcare: A Clarification and Reconceptualization of How
Knowledge Is Generated and Used in Healthcare. Nurs Res Pract. 2012;2012:792519. doi:10.1155/2012/792519.
Ong-Artborirak P, Seangpraw K, Boonyathee S, Auttama N, Winaip rasert P. Health literacy, self-efficacy, self-care behaviors, and gly
cemic control among older adults with type 2 diabetes mellitus: a cross-sectional study in Thai communities. BMC Geriatr. 2023;23: 297. doi:10.1186/s12877-023-04010-0
Jackson IL, Eshiet UI, Onung SI, Egbe ES. Diabetes management selfefficacy and glycaemic control among people with type 2 diabetes
in a resource-limited setting. Discov Public Health. 2025;22:35. doi:10.1186/s12982-025-00423-x
Zhao X, Liu Q, Guo X, Hu X, Cheng L. Serial mediation roles of empowerment and self-care activities connecting health literacy, quali
ty of life, and glycemic control in people with type 2 diabetes. Worldviews Evid Based Nurs. 2024;21(3):330-7. doi:10.1111/wvn.12684.
Hussein SH, Albatineh AN, Almajran A, Ziyab AH. Association of health literacy and other risk factors with glycemic control among
patients with type 2 diabetes in Kuwait: A cross-sectional study. Prim Care Diabetes. 2021;15(3):571-7. doi:10.1016/j.pcd.2021.01.011
Tegegne KD, Gebeyehu NA, Yirdaw LT, Yitayew YA, Kassaw MW. Determinants of poor glycemic control among type 2 diabetes in Ethi
opia: a systematic review and meta-analysis. Front Public Health. 2024;12:1256024. doi:10.3389/fpubh.2024.1256024
Gouveia-Bezerra KM, de Oliveira-Tito-Borba AK, de Oliveira-Marques AP, Gomes-da Silva-Carvalho Q, da Silva-Santos AH, Ramos-Ventura-da Silva-Cavalcanti B. Conocimiento y autoeficacia en personas con Diabetes Mellitus tipo 2. Enferm Glob. 2023;22 (71):68-109. doi:10.6018/eglobal.553591
Asmat K, Sivarajan Froelicher E, Dhamani KA, Gul R, Khan N. Effect of patient-centered self-management intervention on glycemic control, self-efficacy, and self-care behaviors in South Asian adults with type 2 diabetes mellitus: A multicenter randomized controlled trial. J Diabetes. 2024;16(9):e13611. doi:10.1111/17530407.13611.
Bilgehan T, Vardar İnkaya B. The effect of a holistic nurse coaching intervention on glycemic control, diabetes self-management, and
empowerment: a randomized controlled trial. BMC Nurs. 2025;24: 627. doi:10.1186/s12912-025-03252-0
Changsieng P, Pichayapinyo P, Lagampan S, Lapvongwatana P. Implementation of Self-Care Deficits Assessment and a Nurse-Led Supportive Education Program in Community Hospitals for Behavior Change and HbA1c Reduction: A Cluster Randomized Controlled Tri
al. J Prim Care Community Health. 2023;14:21501319231181106. doi:10.1177/21501319231181106
Terkes N, Bektas H, Balci MK. Effect of web-based education in tervention on blood glucose control, self-care and quality of life in patients with type 2 diabetes: A single-blinded randomized controlled trial. Int J Nurs Pract. 2024;30(6):e13298. doi:10.1111/ijn.13298
Esmailpour A, Ilali E, Papi S, Fendereski A, Kashi Z, Razeghi Jahromi S. Effects of a Mobile Health Diabetes Self-care Program on HbA1C,
FBS and Self-care in Older Adults with Type 2 Diabetes: A Randomized Controlled Trial. J Nurs Midwifery Sci. 2025;12(1):e156857.
doi:10.5812/jnms-156857
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71
Panagiotidis P, Kalokairinou A, Tzavara C, Michailidou A, Velonaki VS. Evaluation of a Family-Based, Health Literacy-Adapted Educa
tional Intervention Program in Patients With Type 2 Diabetes Mellitus. Cureus. 2025;17(3):e80239. doi:10.7759/cureus.80239
Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453-7. doi:10.1016/S0140-6736(07)61602-X
Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ.
2010;340:c332. doi:10.1136/bmj.c332
Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Scheckel R, et al. Systematic reviews of etiology and risk. In: Aromataris E, Munn Z,
editors. JBI Manual for Evidence Synthesis. JBI; 2020. Available from: https://jbi-global-wiki.refined.site/space/MANUAL
Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. doi:10.1136/bmj.l4898
Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes selfcare activities measure: results from 7 studies and a revised scale.
Diabetes Care. 2000;23(7):943-50. doi:10.2337/diacare.23.7.943
Van der Bijl JJ, van Poelgeest-Eeltink A, Shortridge-Baggett L. The psychometric properties of diabetes management self-efficacy
scale for patients with type 2 diabetes mellitus. J Adv Nurs. 1999;30 (2):352-9. doi:10.1046/j.1365-2648.1999.01124.x
Anderson RM, Funnell MM, Fitzgerald JT, Marrero DG. The Diabetes Empowerment Scale: a measure of psychosocial self-efficacy. Diabetes Care. 2000;23(6):739-43. doi:10.2337/diacare.23.6.739
Fadli F, Nursalam N, Sjattar EL, Uly N. Improving self-care, HbA1c control, and quality of life in type 2 diabetes: a self-regulation intervention based on the individual and family self-management theory. Front Clin Diabetes Healthc. 2026;6:1712334. doi:10.3389/fcdhc.2025.1712334
Wang X, Tian B, Zhang S, Zhang J, Yang W, Li J, et al. Diabetes knowledge predicts HbA1c levels of people with type 2 diabetes mellitus in rural China: a ten-month follow-up study. Sci Rep. 2023;13: 18248. doi:10.1038/s41598-023-45312-y
Trief PM, Wen H, Burke B, Uschner D, Anderson BJ, Liu X, et al. Psychosocial Factors and Glycemic Control in Young Adults With Youth Onset Type 2 Diabetes. JAMA Netw Open. 2024;7(4):e245620. doi:10.1001/jamanetworkopen.2024.5620
Gao Y, Xiao J, Han Y, Ji J, Jin H, Mawen DG, et al. Self-efficacy mediates the associations of diabetes distress and depressive symptoms with type 2 diabetes management and glycemic control. Gen Hosp Psychiatry. 2022;78:87-95. doi:10.1016/j.genhosppsych.2022.06.003
Gucciardi E, Xu C, Vitale M, Lou W, Horodezny S, Dorado L, et al. Evaluating the impact of onsite diabetes education teams in primary care on clinical outcomes. BMC Fam Pract. 2020;21:48. doi:10.1186/2875-020-01111-2
Ağralı H, Akyar İ. The effect of health literacy-based, health beliefconstructed education on glycated hemoglobin (HbA1c) in people
with type 2 diabetes: A randomized controlled study. Prim Care Diabetes. 2022;16(1):173-8. doi:10.1016/j.pcd.2021.12.010
Sriklo M, Tamdee D, Aungwattana S, Kaewthummanukul T. Effects of Enhance Health Literacy through Transformative Learning Program on Self-Management and Hemoglobin A1C Level Among Adults with Uncontrolled Type 2 Diabetes: A Randomized Controlled Trial. Pac Rim Int J Nurs Res. 2023;27(2):317-33. doi:10.60099/prijnr.2023. 262041
Curtis LM, Davis TC, Arnold CL, Gan JM, McSweeney JC, Hur S, et al. Effectiveness of a health literacy intervention to improve diabetes outcomes in rural family medicine clinics: a randomized pragmatic trial. Health Lit Commun Open. 2024;2(1):2382133. doi:10.1080/2
8355245.2024.2382133
Wang L, Fang H, Xia Q, Liu X, Chen Y, Zhou P, et al. Health literacy and exercise-focused interventions on clinical measurements in Chinese diabetes patients: A cluster randomized controlled trial. EClinicalMedicine. 2019;17:100211. doi:10.1016/j.eclinm.2019.11.004.
Ibrahim NF, Nofal HA, Ali HT, El-Rafey DS, Almadani N, Mahfouz R, et al. Enhancing self-care management in diabetic patients: a randomized controlled trial exploring the interplay of social support, self-efficacy, and empowerment. Acta Diabetol. 2025;62:1691-701. doi:10.1007/s00592-025-02498-z
Ranjbaran S, Shojaeizadeh D, Dehdari T, Yaseri M, Shakibazadeh E. The effectiveness of an intervention designed based on health action process approach on diet and medication adherence among patients with type 2 diabetes: a randomized controlled trial. Diabetol Metab Syndr. 2022;14:3. doi:10.1186/s13098-021-00773-x
Zhang A, Wang J, Wan X, Zhang Z, Zhao S, Bai S, et al. Community-Based Intelligent Blood Glucose Management for Older Adults With Type 2 Diabetes Based on the Health Belief Model: Randomized Controlled Trial. JMIR Mhealth Uhealth. 2025;13:e60227. doi:10.2196/60227
Association of Diabetes Care and Education Specialists, Kolb L. An Effective Model of Diabetes Care and Education: The ADCES7 Self Care Behaviors. Sci Diabetes Self Manag Care. 2021;47(1):30-53. doi:10.1177/0145721720978154
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October 22 2026
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Martínez-García SJ, Liriano-Parra E, Suriel-Rosario FA. Translational nursing: a systematic review of behavioral determinants and glycemic control in adults with type 2 diabetes. Rev Enferm Inst Mex Seguro Soc [Internet]. 2026 Oct. 22 [cited 2026 Oct. 23];34(4):e1616. Available from: https://revistaenfermeria.imss.gob.mx/index.php/revista_enfermeria/article/view/1616