Navigating Diabetes: Enhancing Self-Management through Education among Diabetic People at the Early Stages of the Disease—A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Search Methods
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- Population-related terms: “diabetes mellitus type 2”, “diabetes mellitus II”, “type 2 diabetic patients”, “patients with T2DM”, “patients diagnosed within the last 0–5 years”;
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- Intervention-related terms: “educational intervention”, “diabetes self-management education program evaluation”, “diabetes self-management program effectiveness”, “diabetes self-care education”, and “lifestyle intervention”;
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- Comparator/control-related terms: “assessing changes in the intervention group (IG) and control group (CG)” and “evaluating changes in IG (intervention group) and CG (control group)”;
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- Outcome-related terms: “assessment”, “evaluation”, “examination”, “measurement”.
2.3. Data Extraction
2.4. Synthesis of the Results
3. Results
3.1. Overview of the Studies
3.2. Impacts of Educational Interventions on Biomedical Results
3.2.1. The Impacts of Educational Interventions on HbA1c Levels (Table 5)
Studies’ General Information | Pre-Intervention | Post-Intervention | Change | Absolute Effect | |||
---|---|---|---|---|---|---|---|
IG | CG | IG | CG | IG | CG | ||
Effect of educational intervention on HbA1c | |||||||
[22] | 8.44 ± 2.28 | 8.95 ± 2.34 | 6.92 ± 1.27 * | 7.82 ± 12.98 *# | −1.52 $ | −1.13 | −0.39 |
[23] | 7.20 (6.40, 9.10) | 7.90 (6.80, 10.30) | 6.20 (5.80, 6.60) * | 6.70 (6.40, 7.30) * | −1 ** | −1.2 | +0.2 |
[26] | 6.66 ± 1.09 | 6.86 ± 1.34 | 5.85 ± 0.37 * | 6.97 ± 1.18 | −0.81 ** | +0.11 | −0.70 |
[27] | 9.82 ± 2.47 | 9.05 ± 2.32 | 6.76 ± 0.50 * | 7.25 ± 0.98 * | −3.03 ** | −1.8 | −1.23 |
[28] | 9.5 ± 2.1 | 9.5 ± 2.0 | 7.4 ± 1.5 * | 9.5 ± 2.1 | −2.1 ** | 0 | −2.1 |
[30] | 5.95 ± 0.47 | 5.95 ± 0.47 | 5.14 ± 0.36 * | 5.85 ± 0.37 * | −0.81 ** | −0.1 | −0.71 |
[32] | 6.5 (6.2–7.0) | 6.6 (6.3–7.1) | 6.6 (6.3–7.1) | 6.7 (6.3–7.1) | +0.1 *# | +0.1 | 0 |
[34] | 7.2 (6.6–9.2) | 6.7 (6.4–7.5) | 6.2 (5.8–6.7) * | 6.4 (5.8–6.8) | −1 $ | −0.3 | −0.7 |
[35] | 7.77 ± 2.22 | No control group | 7.16 ± 1.62 | No control group | −0.61 *# | − | −0.61 |
[36] | 7.85 ± 1.19 | 7.32 ± 1.23 | 6.66 ± 0.84 * | 6.95 ± 1.31 | −1.19 ** | −0.37 | −0.82 |
[37] | 8.0 (1.6) | - | 6.2 (1.1) * | - | −1.8 *# | − | −1.6 ± 0.5 |
[40] | 9.1 ± 2.3 | - | 7.4 ± 1.3 * | - | −1.7 ± 2.5 * | − | −1.7 ± 1 |
Mean ± SD | −1.18 ± 0.21 | −0.277 ± 0.13 | −0.64 ± 0.08 | ||||
Effect of educational intervention on FBG | |||||||
[23] | 8.00 | 8.00 | 6.78 * | 7.70 * | −1.22 $ | −0.3 | −0.92 |
[24] | 8.43 ± 1.25 | 8.51 ± 1.17 | 7.03 ± 1.01 * | 7.68 ± 1.12 | −1.4 ** | −0.83 | −0.57 |
[25] | 9.964 ± 2.707 | 10.490 ± 2.781 | 7.792 ± 0.925 * | 9.042 ± 1.561 | −2.172 ** | −1.448 | −0.72 |
[28] | 10.9 ± 3.6 | 11.5 ± 3.9 | 7.5 ± 2.3 * | 8.4 ± 2.8 * | −3.4 ** | −3.1 | −0.3 |
[32] | 7.4 | 7.3 | 7.9 | 7.5 | +0.5 *# | +0.2 *# | +0.3 |
[38] | 5.75 ± 1.01 | 6.55 ± 1.76 | 5.66 ± 1.20 | 6.73 ± 2.66 | −0.09 *# | +0.18 | 0.27 |
Mean ± SD | −1.656 ± 2.11 | −2.839 ± 2.31 | −0.32 ± 1.16 | ||||
Effect of educational intervention on PBG | |||||||
[23] | 13.29 | 12.67 | 7.90 * | 10.58 * | −5.39 $ | −2.09 | −3.3 |
[24] | 11.21 ± 1.65 | 11.34 ± 1.73 | 9.52 ± 1.05 * | 10.43 ± 1.24 | −1.69 ** | −0.91 | −0.78 |
[25] | 14.612 ± 4.685 | 14.692 ± 4.400 | 9.980 ± 1.446 * | 12.275 ± 2.120 | −4.632 ** | −2.417 | −2.215 |
[28] | 17.1 ± 4.6 | 17.2 ± 4.9 | 12.5 ± 3.3 * | 12.7 ± 3.6 * | −4.6 *# | −4.5 | −0.1 |
Mean ± SD | −4.078 ± 2.35 | −2.479 ± 2.41 | −1.598 ± 0.23 |
3.2.2. The impacts of Educational Interventions on FBG and PBG Values
3.2.3. The Impacts of Educational Interventions on Lipid Profiles
3.2.4. The impacts of Educational Interventions on Anthropometric Parameters
3.2.5. The Impacts of Educational Interventions on Blood Pressures
3.3. The impacts of Educational Interventions on Emotional and Social Results
3.4. The Impacts of Educational Interventions on Behavioral Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
References
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Inclusion Criteria | Exclusion Criteria | |
---|---|---|
Publication Date | January 2017–November 2022 | <2017 |
Study Design | RCTs 1 and non-randomized controlled studies, intervention studies, and cohort studies | Nonintervention studies 2 |
Population | Adults ≥ 18 years old, diabetic patients Patients at the early stages of the disease 3 ≤5 years from diagnosis with an oral hypoglycemic agent and lifestyle intervention | Children, not newly diagnosed T2DM patients ≥5 years from diagnosis with type 2 diabetes |
Intervention | Different interventions are used for health education. Face-to-face intervention -Online intervention No changes in medication treatment during the study | Drug-based intervention with changes in medication treatment |
Control Group | Standard care, routine care if it is present | |
Effectiveness Assessment | Biomedical results Behavioral results Emotional and social results |
Studies’ General Information | Random Sequence Generation | Allocation Concealment | Blinding of Participants and Personnel | Blinding of Outcome Assessment | Incomplete Outcome Data | Selective Reporting | Other Biases | Study Quality |
---|---|---|---|---|---|---|---|---|
[22] (2019) China | + | + | − | ? | + | ? | + | Fair |
[23] (2018) China | ? | ? | − | ? | + | + | + | Poor |
[24] (2018) China | + | ? | ? | ? | + | ? | + | Poor |
[25] (2019) China | − | ? | ? | + | + | + | − | Poor |
[26] (2022) China | + | + | + | + | + | + | ? | Fair |
[27] (2018) China | − | ? | ? | + | + | + | ? | Poor |
[28] (2019) India | + | + | + | + | + | + | + | Fair |
[29] (2018) India | ? | + | − | ? | + | − | + | Poor |
[30] (2020) India | + | + | ? | ? | + | + | ? | Fair |
[31] (2022) India | + | + | ? | ? | + | + | + | Fair |
[32] (2019) Netherlands | + | + | − | ? | + | + | + | Fair |
[33] (2019) Netherlands | + | + | − | ? | + | + | + | Fair |
[34] (2018) Spain | − | ? | ? | + | − | + | − | Poor |
[35] (2019) Mexico | − | − | − | ? | + | + | No control group | Poor |
[36] (2018) Italy | ? | ? | ? | ? | + | + | ? | Poor |
[37] (2022) USA | ? | ? | ? | ? | + | + | No control group | Poor |
[38] (2020) UK | + | + | + | ? | + | + | ? | Fair |
[39] (2021) Germany | − | ? | ? | ? | + | + | No control group | Poor |
[40] (2017) Lebanon | − | ? | ? | ? | + | + | No control group | Poor |
Studies’ General Information | Total Number of Participants/Numbers of Participants in Intervention Group/Control Group | Demographic Characteristics | Significant Baseline Differences between Groups | Duration of Diabetes Diagnosis | Setting(s) |
---|---|---|---|---|---|
[22] (2019) China | 97 participants IG: 49 CG: 48 | Average age: 63.71 years | No significant differences between groups | Diagnosis received within the prior 3 months | Outpatient ward |
[23] (2018) China | 118 participants IG: 63 CG: 55 | Mean age: 54 ± 11.5 | No significant differences between groups | Newly diagnosed T2DM | Outpatients and inpatients |
[24] (2018) China | 106 patients IG: 53 CG: 53 | Mean age: 58.62 ± 15.74 years old | No significant difference between groups | 1.24 years ± 0.35 years | Hospitalized patients |
[25] (2019) China | 358 participants IG: 179 CG: 179 | Mean age of 50.1 ± 9.1 years | No significant difference between the two groups (p > 0.05) | Newly diagnosed T2DM | Outpatient ward |
[26] (2022) China | 128 participants IG: 64 CG: 64 | Average age: 57.43 years, and 41.4% were female | No significant differences between groups | Newly diagnosed T2DM (Diagnosed in the preceding 3 to 9 months) | Primary healthcare services |
[27] (2018) China | 126 participants IG: 66 CG: 60 | Mean age: 32.71 ± 5.69 | No significant differences between groups | Newly diagnosed T2DM (Duration < 6 months) | Outpatients |
[28] (2019) India | 248 participants IG: 126 CG: 122 | The mean age was 43 ± 8.7 years, and 32.3% were women. | No significant differences between groups | Newly diagnosed T2DM | Outpatient ward |
[29] (2018) India | 96 participants IG: 48 CG: 48 | The age group was from 25 to 65 years. | Not clear | Newly diagnosed T2DM | Medical outpatient ward |
[30] (2020) India | 136 participants IG: 66 CG: 70 | Mean ages (IG: 37.2 ± 4.09 and CG: 37.55 ± 4.29); 41.89% were female | Not clear | Newly diagnosed T2DM | Medical outpatient ward |
[31] (2022) India | 66 participants IG = 33 CG = 33 | Mean age: 42.29 ± 9.5; 66.66% Male | No significant differences between groups | Newly diagnosed T2DM (Within 3 months of diagnosis) | Endocrinology outpatient ward |
[32] (2019) Netherlands | 108 participants IG: 56 CG: 52 | Mean age: 62.3 ± 7.8 | There were some differences between groups in the prevalence of diabetes-related complications. | Newly diagnosed T2DM (Diabetes duration from 3 months to 5 years) | Outpatient ward |
[33] (2019) Netherlands | 137 participants IG: 62 CG: 75 | Mean age: 63.6 (10.2) | No significant differences between groups | Newly diagnosed T2DM (Diabetes duration 1–3 years) | Outpatients |
[34](2018) Spain | 271 participants IG: 134 CG: 137 | IG 65.6 ± 10.6 CG 67.5 ± 13.5 | Not clear | Newly diagnosed T2DM, 1 year after diagnosis | Primary health centers |
[35] (2019) Mexico | 288 patients who had followed the program No control group | The mean age was 51.1 ± 10.3 years, and 56.2% were women. | Not clear | ≤5 years after diagnosis with T2DM | Outpatient ward |
[36] (2018) Italy | 95 participants IG: 47 CG: 48 | Mean age: 58.43 ± 7.34 | No significant differences between groups | Newly diagnosed T2DM (Diagnosed within the previous 12 months) | Outpatient ward |
[37] (2022) USA | 17 participants No control group | Mean age: 52 years | Not clear | Newly diagnosed T2DM (Diagnosed within the past 12 months) | Outpatients |
[38] (2020) UK | 18 participants IG: 9 CG: 9 | Mean age: 56 (6.5); F/M: 50%/50% | No significant differences between groups | Newly diagnosed T2DM (Diagnosed within the past 4 years | Outpatients |
[39] (2021) Germany | 24 participants No control group | Mean age: 56 (6.5); F 58% | - | Newly diagnosed T2DM (Diabetes duration < 4 years) | Outpatients |
[40] (2017) Lebanon | 75 participants No control group | Mean age: 55 ± 10.7; 552% Female | - | Newly diagnosed T2DM | Diabetes outpatient clinics |
Studies’ General Information | Type of Study | Type of Intervention | Follow-up Period | Characteristics of Educational Interventions | Theoretical Basis | Assessed Outcomes | ||||
---|---|---|---|---|---|---|---|---|---|---|
Educational Sessions, Duration | Delivery | Provider | Covered Self-Care Topics | Supporting Strategy | ||||||
[22] (2019) China | Experimental design/RCTs | Health promotion–multi-intervention program Individual intervention | 18 months | Different return visit times for each patient Mobile application | Face-to-face and online | Team | General information for diabetes Self-care | Mobile and tablets | AADE 7 Self-Care Behaviors program | Biomedical outcomes Psychosocial outcomes |
[23] (2018) China | Experimental design | Education program–multi-intervention program Group education | 6 months | 2 lecture sessions and interactive sessions | Face-to-face | Nurses | General information for diabetes Self-care | Lecturing, audio-visual, and discussion approach | Problem-based learning | Biomedical outcomes Psychosocial outcomes |
[24] (2018) China | Intervention study | Education program–multi-intervention program Group education “One-to-one” health education | 3 months | Not clear | Face-to- face | Nurses | General information for diabetes Self-care | none | Orem’s self-care theory | Biomedical outcomes Psychosocial outcomes |
[25] (2019) China | Non-randomized controlled study | Implementation of a model Group education | 6 months | The first education was outpatient education. Follow-up telephone visits | Face-to-face and phone call visits | Team | General information for diabetes Self-care | Learning manual, video tutorials, phone calls, diabetes clubs, meetings | Omaha System-based integrated nursing management model | Biomedical outcomes Psychosocial outcomes |
[26] (2022) China | RTCs | Multi-intervention program Group education | 12 weeks | 8 interactive educational sessions | Face-to-face | Nurses | General information for diabetes Self-care | Handbook and PowerPoint slides | Health belief model and Self-efficacy theory | Biomedical outcomes Psychosocial outcomes Behavioral outcomes |
[27] (2018) China | Prospective cohort study | Education program–multi-intervention program Individual intervention Mobile application | 24 weeks | Use of the medical app to assist in doctor–patient communication, | Online | Physician | General information for diabetes Self-care | Use of other functions of the app software | None | Biomedical outcomes |
[28] (2019) India | RCTs | Education program–multi-intervention program Individual intervention | 24 months | Advice from 2–3 educatory text messages per week | Text message Face-to-face | Physicians | General information for diabetes Self-care | None | None | Biomedical outcomes Psychosocial outcomes Behavioral outcomes |
[29] (2018) India | RCTs | Education program–multi-intervention program Group intervention | 4 months | 1 session for 7–15 min | Face-to-face | Not clear | General information for diabetes Self-care | Video leaflets | None | Psychosocial outcomes |
[30] (2020) India | RCTs | Structured exercise therapy Individual intervention | 6 months | Aerobic exercise | Face-to-face | Physicians | Role of specific exercise | Booklets | None | Biomedical outcomes |
[31] (2022) India | RCTs | Physical promotion Individual intervention | 12 months | Contacted by phone at 3-month intervals | Calls and face-to-face | Not clear | Role of physical activity | No information | None | Biomedical outcomes Behavioral outcomes |
[32] (2019) Netherlands | RCTs | Education program–multi-intervention program Individual and group intervention | 30 months | two individual and five group sessions | Face-to-face | Nurses | General information for diabetes Self-care | Telephone consultation, | None | Biomedical outcomes Psychosocial outcomes Behavioral outcomes |
[33] (2019) Netherlands | RCTs | Education program–multi-intervention program Group intervention | 8 months | Three monthly 2-h interactive sessions and one booster session | Face-to-face | Nurses | Illness perceptions | Workbook for both patients and partners. | None | Psychosocial outcomes Behavioral outcomes |
[34] (2018) Spain | Prospective study | PAET-Debut DM2 Standardized group education Group education | 12 months | Three phases | Face-to-face | Team | General information for diabetes Self-care | Standardized materials | AISBE group for chronic diabetes disease | Biomedical outcomes Psychosocial outcomes Behavioral outcomes |
[35] (2019) Mexico | Program evaluation study | Implementation of the CAIPadi model Individual intervention | 24 months | Intervention visits and two follow-up visits (12 and 24 months) | Face-to-face | Team | General information for diabetes Self-care | Support in distance system webpage | CAIPaDi program | Biomedical outcomes Psychosocial outcomes Behavioral outcomes |
[36] (2018) Italy | Intervention study | Psychological intervention Group intervention | 12 months | 90 min biweekly group sessions over 3 months | Face-to-face | Clinical psychologist | General information for diabetes Self-care | None | No | Biomedical outcomes |
[37] (2022) USA | Intervention study | Education program–multi-intervention program Individual intervention | 6-week intervention and 3-month follow-up | Four sessions | Face-to-face | Not clear | Role of foods and physical activity | The GEM pocket guide; Text messages | None | Biomedical outcomes Psychosocial outcomes Behavioral outcomes |
[38] (2020) UK | RCTs | Education program–multi-intervention program Individual intervention | 8 weeks | Participants received two text messages per week | Online | Not clear | Behavioral change | Use of a mobile application | Theory of planned behavior | Behavioral outcomes |
[39] (2021) Germany | Intervention study | Food-based digital education Individual intervention Mobile application | 12 weeks | During the weekly coaching calls | Online | Trained nutritionist | Structured behavioral change Role of a healthy diet | Recipe book | None | Biomedical outcomes |
[40] (2017) Lebanon | Descriptive pre-/poststudy | Food education Individual intervention Mobile platform | 12 months | 5 visits | Face-to-face and online | Six Lebanese dietitians | General information for diabetes Self-care | No information | Academy of Nutrition and Dietetics EBNPGs | Biomedical outcome Behavioral outcomes |
Studies’ General Information | Pre-Intervention | Post-Intervention | Change | Absolute Effect | |||
---|---|---|---|---|---|---|---|
IG | CG | IG | CG | IG | CG | ||
Effect of educational intervention on weight | |||||||
[22] | 67.86 ± 16.84 | 66.67 ± 17.28 | 57.5 ± 15.33 * | 65.65 ± 16.98 | −10.36 ** | −1.02 | −9.34 |
[31] | 71.47 ± 11.43 | 71.47 ± 11.43 | 69.27 ± 13.88 | 71.20 ± 12.76 | −2.2 | −0.27 | −1.93 |
[32] | 88.2 ± 16.2 | 87.7 ± 15.4 | 86.6 ± 16.1 | 86.7 ± 14.1 | −1.6 | −1 | −0.6 |
[38] | 89.60 ± 20.3 | 90.2 ± 19.9 | 90 ± 21.7 | 90.5 ± 19.2 | +0.4 | +0.3 | +0.1 |
[39] | 97.0 ± 13.9 | - | 87.7 ± 12.1 * | - | −9.3 | −9.3 | |
Mean ± SD | −4.6 | −0.49 | −2.94 | ||||
Effect of educational intervention on BMI | |||||||
[22] | 25.47 (3.31) | 25.29 (3.25) | 25.28 (2.93) | 24.94 (2.89) | −0.19 | −0.35 | −0.16 |
[23] | 25.70 ± 3.38 | 25.06 ± 3.38 | 25.16 ± 3.38 | 25.28 ± 3.47 | −0.54 | +0.02 | −0.56 |
[27] | 26.27 ± 4.64 | 25.52 ± 4.76 | 25.68 ± 4.21 | 25.48 ± 4.65 | −0.59 | −0.04 | −0.55 |
[31] | 27.73 ± 5.14 | 26.80 ± 2.76 | 26.97 ± 5.04 | 26.66 ± 3.18 | −0.76 | −0.14 | −0.62 |
[32] | 29.6 (4.9) | 30.1 (4.5) | 29.2 (4.8) * | 29.6 (4.5) | −0.4 | −0.5 | −0.1 |
[34] | 29.6 (27.2–34.2) | - | 28.8 (25.9–32.6) * | - | −0.8 * | −0.8 | |
[35] | 29.19 ± 4.27 | - | 28.8 ± 4.2 | - | −0.39 | −0.39 | |
[37] | 36.5 (8.1) | - | 34.4 (8.2) | - | −2.1 | −2.1 | |
[38] | 31.1 ± 6.4 | 29.9 ± 4.7 | 31.2 ± 6.9 | 31.2 ± 4.6 | +0.1 | +1.3 | − |
[39] | 32.6 ± 4.6 | - | 29.4 ± 3.9 * | - | −3.2 | −3.2 | |
[40] | 31.7 ± 4.9 | - | 30.6 ± 4.9 * | - | −1.1 ± 2.7 * | −1.1 | |
Mean ± SD | −0.90 | 0.29 | −0.398 |
Blood Pressure/Studies’ General Information | [22] | [23] | [31] | [32] | [34] | [35] | [38] | [40] | Mean ± SD | ||
---|---|---|---|---|---|---|---|---|---|---|---|
SBP | Pre-intervention | IG | 130.24 ± 18.92 | 130.00 | 128.09 ± 10.78 | 132 ± 13 | 130.64 ± 13.5 | 128.9 ± 16.4 | 136.3 ± 17.2 | 131.3 ± 20.4 | |
CG | 128.09 ± 17.36 | 120.00 | 129.48 ± 10.71 | 133 ± 14 | - | - | 134.0 ± 18.1 | ||||
Post-intervention | IG | 131.37 ± 19.12 | 130.00 | 119.15 ± 7.75 | 135 ± 17 | 129.4 ± 14.4 | 120.86 ± 11.83 | 138.2 ± 20.7 | 124.9 ± 9.9 * | ||
CG | 131.15 ± 18.24 | 130.00 | 119.88 ± 7.31 | 135 ± 15 | - | - | 135.6 ± 20.3 | ||||
Change | IG | 1.13 | 0 | −8.94 | 3.0 | 1.24 | −8.04 | 1.9 | −6.4 * | −2.3 ± 6.5 | |
CG | 3.06 | 10.00 | −9.6 | 3 | 1.6 | 1.61 ± 8.10 | |||||
Absolute Effect | - | −0.66 | 0 | - | −8.04 | - | −6.4 * | −0.34 ± 7.9 | |||
DBP | Pre-intervention | IG | 74.99 ± 13.12 | 80.00 | 79.33 ± 8.14 | - | 77.8 ± 9 | 78.4 ± 7.87 | 83.8 ± 9.5 | 81.3 ± 12.5 | |
CG | 76.22 ± 12.11 | 80.00 | 81.24 ± 8.03 | - | - | 83.3 ± 10.7 | |||||
Post-intervention | IG | 75.58 ± 11.04 | 80.00 | 78.15 ± 4.83 | - | 76.4 ± 8.4 | 74.06 ± 6.86 | 82.4 ± 9.8 | 78.1 ± 9.5 | ||
CG | 78.61 ± 12.98 | 85.00 | 78.73 ± 5.78 | - | - | - | 84.3 ± 13.2 | ||||
Change | IG | −0.59 | 0 | 1.18 ± 6.48 | - | −1.4 | 4.34 | −1.3 | −3.1 * | −0.87 ± 4.5 | |
CG | 2.39 | 0.5 | 2.51 ± 6.90 | - | 1.0 | 1.6 ± 5.1 | |||||
Absolute Effect | 3.98 | 0.5 | 1.33 | - | - | 4.34 | 2.3 | -3.1 | 0.36 ± 5.5 |
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Kiçaj, E.; Saliaj, A.; Çerçizaj, R.; Prifti, V.; Qirko, S.; Rogozea, L. Navigating Diabetes: Enhancing Self-Management through Education among Diabetic People at the Early Stages of the Disease—A Systematic Review. Int. J. Environ. Res. Public Health 2024, 21, 522. https://doi.org/10.3390/ijerph21050522
Kiçaj E, Saliaj A, Çerçizaj R, Prifti V, Qirko S, Rogozea L. Navigating Diabetes: Enhancing Self-Management through Education among Diabetic People at the Early Stages of the Disease—A Systematic Review. International Journal of Environmental Research and Public Health. 2024; 21(5):522. https://doi.org/10.3390/ijerph21050522
Chicago/Turabian StyleKiçaj, Emirjona, Aurela Saliaj, Rudina Çerçizaj, Vasilika Prifti, Sonila Qirko, and Liliana Rogozea. 2024. "Navigating Diabetes: Enhancing Self-Management through Education among Diabetic People at the Early Stages of the Disease—A Systematic Review" International Journal of Environmental Research and Public Health 21, no. 5: 522. https://doi.org/10.3390/ijerph21050522