Lifestyle Medicine Case Manager Nurses for Type Two Diabetes Patients: An Overview of a Job Description Framework—A Narrative Review

Abstract

Background: Lifestyle medicine (LM) is a contemporary scientific discipline with a multidisciplinary approach. Case Management offers a viable alternative for the care of patients with Type 2 Diabetes (T2D). This study aimed to identify the role and clinical applications of the lifestyle medicine case manager nurse (LMCMN) for T2D patients internationally and to analyze the role of specialist nurses in Italy through a narrative review. A secondary objective was to define a job description (JD) for a future Delphi method. Methods: A narrative review of the literature was conducted using PubMed/Medline, Scopus, and grey literature sources to analyze the international and Italian regulatory contexts. Subsequently, a JD for the LMCMN was developed for application in a future Delphi Study. Results: Nurses play a strategic role in managing T2D, and the LM approach has demonstrated strong evidence of effectiveness. This study developed a specific JD for the LMCMN suitable for both Italian and international contexts. Conclusions: The specific role of the LMCMN is still underdeveloped internationally. In the context of territorial assistance and chronic disease management, this professional is crucial for delivering quality care and shaping health policies that meet community needs.

1. Introduction

Lifestyle medicine (LM) is a scientific discipline with a multidisciplinary approach that primarily focuses on the prevention, treatment, and research of major chronic diseases related to modifiable environmental factors such as poor diet, physical inactivity, stress, the excessive consumption of alcohol, and smoking [1,2]. LM is especially concerned with prevention and the overall clinical well-being of individuals [3]. Studies indicate that chronic conditions such as Type 2 Diabetes (T2D), cardiovascular diseases, and cancer can be prevented or treated more effectively with a lifestyle-focused approach, reducing their incidence and related complications by about 80% and increasing patient life expectancy [4,5,6]. Diabetes (IDF 2021) currently affects 425 million people worldwide (age range: 20–79; T2D range: 87–91%).

Projections for 2045 suggest a significant increase in the disease’s prevalence (629 million; age range: 20–79 years), which will correlate with a rise in global healthcare costs [7]. In Italy, the prevalence of this condition was estimated at 4 million people in 2023 [8].

Most diabetic patients are obese and sedentary (males = 28.9%; females = 32.8%) in the 45–64 age range [9]. Lifestyle changes, especially in light of recent national and international guidelines, could represent a central starting point for the care and management of T2D, both in preventing complications and in treating the acute and chronic phases of the disease. The multidisciplinary approach, also known as “Case Management”, is the optimal therapeutic and care strategy, focusing primarily on meeting the need for self-care and improving the patient’s overall lifestyle [10]. This therapeutic care pathway promotes collaboration among multidisciplinary team members, facilitating the exchange of clinical and care information among patients, caregivers, doctors, nurses, and all involved healthcare professionals. It represents a viable alternative for the care of patients with T2D [11]. Nurses, due to their training and daily proximity to patients, are uniquely positioned to take center stage in Case Management. Their expertise in providing personalized care, continuously monitoring patient conditions, and coordinating with other healthcare professionals is crucial for the success of Case Management [10]. Specifically, specialized nurses possess specific skills in promoting lifestyle changes and managing chronic diseases such as T2D [12]. These skills not only improve patient adherence to therapies but also foster a more holistic and personalized approach to care. Furthermore, the professional perspective of nurses makes them particularly attuned to the emotional and psychological needs of patients, aspects that are critical for effective chronic disease management. The COVID-19 pandemic has further highlighted the importance of an integrated and multidisciplinary approach to care, where nurses play a crucial role in ensuring the continuity and quality of care, quickly adapting to new challenges and changes in clinical guidelines [13]. Within this specific context, the lifestyle medicine case manager nurse (LMCMN) could play a key role in patient management, supporting their care and providing a personalized care pathway, thereby contributing to the overall improvement in the clinical condition [14].

Objectives

This study aimed to identify the role and clinical applications of the LMCMN for T2D patients internationally and to analyze the role of specialist nurses in Italy through a narrative review. A secondary objective was to define a job description (JD) for a future Delphi method.

2. Materials and Methods

2.1. Study Design

A narrative literature review was conducted, according to a previously published methodological study [15], to perform a state-of-the-art review. This type of review aims to summarize the research on a specific topic, highlighting significant changes in understanding and research orientations over time.

2.2. Identification of the Research Question

For this review, the research question was formulated using three components of the PICO model [16]. A PIO approach was adopted, considering the following elements: P (Population): LMCMN; I (Intervention): identification of research studies describing the clinical roles and professional competencies of the LMCMN; and O (Outcome): description of the academic and professional competencies of the LMCMN.

2.3. Inclusion and Exclusion Criteria

The inclusion criteria encompassed primary and secondary studies published in English and Italian, focusing on populations of LMCMNs for TD2. Studies not available in full text were excluded.

2.4. Search Strategy

This study integrated the results of a previous study that analyzed and theorized the clinical care skills of the LMCMN in managing the care of subjects with TD2, in order to provide a possible answer for the new organization of community health after the COVID-19 pandemic [17]. The bibliographic search included the time period up to May 2024, integrating the data from the previous study [17]. The search was initially performed on PubMed and then on Scopus databases, using the keywords “Case manager”, “Nurse Practitioner”, and “Diabetes mellitus”, together with their variants, appropriately combined using Boolean operators AND and OR. Following the initial search to identify the total number of records, the article screening process was conducted by two academic researchers (GC and SM). In cases of disagreement, a third researcher (MS) was involved to reach a consensus. EndNote 20 (© 2024 Clarivate, Philadelphia, United States) was used for the bibliographic management of the analyzed records. The complete search algorithms are available in Appendix A.

In a second phase, the identified international bibliographic research was completed by an analysis of the regulatory and disciplinary framework in Italy. Relevant laws and guidelines were identified through various institutional sources, including the National Prevention Plan 2020–2025 [18], the National Recovery and Resilience Plan [19], the models and standards for the development of Territorial Assistance in the National Health Service [20], urgent measures related to health, employment support, and the economy, as well as social policies connected to the COVID-19 epidemiological emergency [21], and the Guidelines for Family and Community Nurses (FCNs) [22].

2.5. Data Extraction and Synthesis

The selected studies underwent a rigorous two-stage analysis process. Initially, they were categorized based on several criteria: Author/Year, Country, Study Design, Timing, Sample, Principal Interventions, and Results. This categorization ensured a structured approach for synthesizing the identified literature. Following this, a comprehensive narrative synthesis was conducted. This synthesis integrated the results from a previously published study [17] and subsequently presented a narrative overview of the role of the LMCMN in both international and Italian healthcare contexts. Specifically, in the Italian context, the analysis was conducted on the clinical applications of specialist nurses in order to better explore the relevant healthcare context. Finally, the results obtained from the reviewed literature were integrated and utilized to develop a job description for the LMCMN, intended for use in a future Delphi study.

3. Results

3.1. Preliminary Literature Analysis

A previous scoping review [17] demonstrated the importance of the role of the LMCMN in the management of T2D. The results of this review provided solid evidence of the beneficial effects of this approach, supporting the implementation of this professional figure in diabetes care programs. Specifically, this study highlighted that the intervention of these professionals is associated with improvements in the clinical parameters of patients, including glycemic control, blood pressure, and cholesterol levels. It was observed that HbA1c values improved significantly, with p-values ranging from 0.027 to <0.0001. Furthermore, an improvement in the lipid profile (LP) and high-density lipoprotein (HDL) levels was reported (p < 0.0001). A significant reduction in blood pressure (BP) values was also noted (p = 0.001). Additionally, the study observed an improvement in the patients’ quality of life and greater adherence to therapeutic recommendations and lifestyle modifications. However, the authors expressed the need for further research to optimize intervention strategies in order to better understand how these benefits are achieved.

3.2. Literature Screening

A total of 1558 articles were identified through electronic database searches (PubMed/Medline: 342; Scopus: 1216). Of these, 14 records were duplicates, leaving 1544 records for evaluation. After screening the titles and abstracts, 1488 records were deemed irrelevant, and 56 articles were subjected to full-text screening. At this stage, fifty-two articles were excluded, as they did not meet the defined inclusion criteria, resulting in four records being included in this narrative review.

3.3. General Characteristics of Studies Included

The study designs of the included articles consisted of two randomized clinical trials and two quasi-experimental studies, all conducted in different countries: Egypt, Saudi Arabia, South Korea, and Ethiopia. A total of 340 subjects were enrolled in the experimental group, with an equal number in the control group (

Table 1. General characteristics of studies included.

Author/Year	Country	Study Design	Timing	Sample	Principal Interventions	Results
Shaban MM et al., 2024 [23]	Egypt	Quasi-experimental	6 months	Experimental group (n = 60) Control group (n = 60)	Digital-based nursing intervention for diabetes education and lifestyle behavior	The intervention group demonstrated improvements in diet, exercise, medication adherence, blood glucose testing, and foot care
Yaagoob E et al., 2024 [24]	Saudi Arabia	RCT	6- and 12-week follow-up	Experimental group (n = 40) Control group (n = 40)	Use of social media for diabetes education and lifestyle behavior	Significant increase in self-efficacy, self-management, and education in the experimental group
Park S et al., 2024 [25]	South Corea	RCT	12 weeks	Intervention group (n = 60) Control group (n = 60)	Specific App used for diabetes education and lifestyle behavior	The digital self-care intervention was beneficial for blood sugar control
Tamiru S et al., 2023 [26]	Ethiopia	Quasi-experimental	5 months	Intervention group (n = 180) Control group (n = 180)	Nurse-led diabetes self-management education (DSME)-structured	Substantial improvement in diabetes knowledge in the experimental group

Legend: RCT: Randomized Controlled Trial.

).

3.4. Overview of the Role and Clinical Applications of LMCMNs at the International Level

This review provided valuable insights, particularly regarding the technological resources used and their management by a case manager nurse for the nursing management of self-care in patients with T2D. In the study by Shaban et al. [23], which enrolled 60 Egyptian subjects in the experimental group and an equal number in the control group, web-based nursing interventions were assessed using qualitative evaluation scales on self-care and disease knowledge (p < 0.02 and p < 0.001, respectively, between pre- and post-test over 4 months). The study demonstrates the significant potential of this approach, highlighting the nurse’s essential role within the multidisciplinary team, capable of enhancing care and management for patients with T2D in the medium and long term.

The management skills of specialist nurses were also highlighted in an Australian study by Yaagoob et al. [24]. A total of 80 patients with T2D were recruited (40 in the experimental group and 40 in the control group) and observed over a period of 6 weeks. The use of WhatsApp technology by the experimental group demonstrated the potential for improved self-care in disease management and received positive feedback regarding the communicative use of the platform and the presence of specialist nurse support. The study assessed the intervention’s impact both qualitatively using specific scales and quantitatively through glycated hemoglobin (HbA1c) values, which showed significant differences (adjusted mean difference = −0.64, 95% CI −0.94 to −0.33, p = 0.001, Cohen’s d = 0.69). No statistically significant values were found regarding the qualitatively measured aspects.

Analyzing the study by Park et al. [25], 105 Korean subjects over the age of 65 with T2D were included (53 in the experimental group and 52 in the control group). The control group received a self-care intervention managed by specialist nurses, which included bi-weekly phone calls providing support on virtuous environmental behaviors (primarily diet, exercise, and stress management). The experimental group showed statistically significant improvements at one year in terms of HbA1c (p = 0.049), self-care management (p = 0.002), and perceived quality of life (p < 0.001). Similarly, Tamiru et al. [26] evaluated the support of specialist nurses integrated into health education programs for patients with T2D in Ethiopia (180 in the experimental group and 180 in the control group). The intervention lasted six months, and at the end of the trial, improvements were observed in terms of self-care and disease knowledge, which increased compliance and reduced potential complications. The complications decreased from 62.7% to 20.6% for the low level between the pre- and post-test and increased from 11.8% to 54% for the high level within the same period.

3.5. Overview of the Role and Clinical Applications of Specialist Nurses in Italy

This review analyzed the guidelines currently described in national data sources to describe the potential of this particular nursing role and the possibilities for integration into new national care processes. A thorough analysis of the examined documents [18,19,20,21,22] reveals common aspects regarding the role of the nurse in this new vision of care: the multidisciplinary care model positions the nurse in a key role as a professional capable of managing primary, secondary, and tertiary prevention programs for both individuals and their communities. The implementation of modern and efficient organizational models sees the nurse as a central figure in both the organizational and operational phases, promoting the One Health approach [27] in the management of care pathways. The specialist nurse emerges as a strategic professional in the integrated management of complex conditions such as chronic non-communicable diseases, operating autonomously according to the principles of preventive nursing care.

In Italy, these care development programs have led to an increased focus on community healthcare, an essential factor for managing chronic conditions like T2D. Consequently, proximity care and community nursing have undergone significant development. Patients are integrated into a socio-assistance community approach, emphasizing the centrality of the individual and the integration of “Hospital–Community” models. The FCNs become key figures in this context, capable of providing personalized care and coordinating with new community healthcare services such as “Community Houses”. The organizational skills acquired by the FCNs also enable them to manage new healthcare technologies, interact effectively with digital data collection and monitoring models, and actively participate in the implementation of modern organizational models from a Health Technology Assessment (HTA) perspective [28,29] (Figure 1).

3.6. Academic Pathways for Specialist Nurses and Case Managers in Italy

Currently, the role of the LMCMN is not regulated in Italy. However, a case manager nurse must possess specialized skills relevant to the clinical context in which they are employed, as demonstrated by the international literature review. In Italy, the evolution of the “specialist” nurse is relatively recent.

Since 2015, the Italian National Federation of Nursing Professions (FNOPI) has been developing a new model of “competency evolution” [30]. This model introduces a new nursing role with “advanced”, “expert”, and “specialized” clinical competencies. These competencies are divided into two main professional axes: the clinical axis, which encompasses the competencies/responsibilities of nurses towards patients at various incremental levels, and the management axis, which includes competencies related to resource management to ensure the effectiveness and appropriateness of services and high-quality outcomes for patients.

In this context, specific academic training guidelines have been established to certify this particular role. Three distinct pathways have been defined:

Nurse with advanced clinical skills: A nurse who has completed a university advanced training course, which has allowed them to refine their “core” competencies applied to a very specific technical operational area.

Clinical expert nurse with a Master’s degree: A nurse who has completed a first-level university Master’s program, deepening their competencies and applying them in a particular sector of nursing care. This nurse is an expert in specific aspects of the care process or in particular sectoral care practices.

Clinical specialist nurse with a Master’s degree: A nurse who has completed a Master’s degree in Nursing Sciences with a focus on one of the areas specified by the State-Regions Agreement (primary care—territorial/district services; intensive and emergency/urgent care; medical area; surgical area; neonatology/pediatrics; mental health and addictions). This nurse is a clinical specialist capable of directing and managing (setting up, supervising, monitoring, evaluating) both the care processes typical of a specific clinical area, present in any healthcare facility (from the smallest to the most complex, from the most general to the most specialized), and the professional competencies necessary to implement them.

Advanced competency is thus an extension of expert competency, distinguished by the fact that while expert competency is largely acquired through experiential learning, advanced competency is gained through an enrichment in knowledge via university education programs [31].

These educational pathways contribute to defining the role of the “Case Manager”, a specialist nurse who can ensure effective patient care management integrated with community healthcare settings.

At the national level, there are advanced clinical programs such as first-level Master’s degrees (offered by public and/or private universities) designed to provide students with all the tools, techniques, and competencies necessary to coordinate care pathways and interventions. These range from prevention to acute phase treatment and rehabilitation and extend to discharge and long-term care management.

Unfortunately, this role is still not widespread, although it is rapidly developing [32], particularly in specialized fields such as diabetology and the chronic diseases associated with it. Figure 2 outlines the possible university pathway to acquire the competencies of a nursing case manager.

3.7. Job Description for Delphi Method Purposes

Based on the data analyzed from the integrative review of the international literature, supplemented by data analyzed within the Italian national healthcare context, a JD has been developed for use in a future Delphi method. This JD has been crafted to ensure a comprehensive and detailed understanding of the required skills and responsibilities, with the aim of improving the quality and consistency of professional practices in the healthcare sector (

Table 2. JD for Delphi method purposes.

JD FOR LMCMN IN DIABETOLOGY
Regulatory and Legal Framework
Qualification:	Nurse—Category D.
Minimum Education Requirement	Bachelor’s degree in Nursing Science or equivalent titles as per Law 42/1999 “Provisions on healthcare professions” [33].
Career Titles	-PhD; -Master’s degree in nursing and midwifery (LM/SNT1); -First- or second-level Master’s degree in diabetes and/or metabolic diseases; -First- or second-level Master’s degree in LM.
Institutional Obligations	Registration with the National Federation of Nursing Professions.
Key Regulatory, Legislative, and Ethical References	-DM 739/1994, “Regulation regarding the identification and professional profile of the Nurse” [34]; -Law 42/1999, “Provisions on healthcare professions” [33]; -MIUR Interministerial Decree of 19 February 2009, “Determination of degree classes for healthcare professions” [35]; -Law 43/2006, “Provisions on nursing, midwifery, rehabilitation, technical-health, and prevention professions, and delegation to the Government for the establishment of related professional orders” [36]; -DPR 62 of 16 April 2013, “Regulation containing the Code of Conduct for public employees, pursuant to Article 54 of Legislative Decree 30 March 2001, No. 165” [37]; -Law 24/2017, “Provisions on the safety of care and the assisted person, as well as on the professional liability of healthcare professionals” [38]; -Law 3/2018, “Delegation to the Government on clinical trials of medicinal products, and provisions for the reorganization of health professions and for the management of the Ministry of Health” [39]; -2019 Code of Ethics for Nursing Professions [40].
Contractual References	National Collective Labor Agreement (CCNL) for the Healthcare Sector 2016–2018, signed on 21 May 2018 [41].
Training	Participates in company and departmental training programs and, in accordance with Article 2, paragraph 357 of Law 244/2007 of 24 December 2007 [42] and subsequent amendments and integrations, complies with the guidelines for Continuing Medical Education (CME). Enhances personal cultural knowledge by supporting and assisting in clinical, care, and social health activities alongside nursing students during their training internships.
Research	Engages in research and continuous improvement activities. Based on the competencies of their profile and the observation of their professional activity, promotes research projects and the development of specific skills typical of the nursing profession from an LM perspective.
Information Flow	Participates in all health management activities, utilizing the necessary tools to observe performance and socio-health phenomena. Specifically, updates the electronic medical record used at the center on a daily basis.
Organizational and Managerial Macro-Area
Responsibilities	The LM nurse specializing in diabetology is responsible for providing nursing care to patients with diabetes and endocrine disorders. Care for individuals, the community, and families is delivered through specific autonomous and multidisciplinary interventions in the areas of prevention, promotion, and rehabilitation of therapeutic treatments within an LM framework. By integrating with the multidisciplinary team, the nurse implements the nursing process in the phases of Assessment, Diagnosis, Planning, Implementation, and Evaluation of the Individualized Care Plan (ICP) for patients with diabetes and/or endocrine disorders.
Objectives	Ensure that the nursing needs of patients with diabetes are met, providing consistent care throughout all phases of the ICP.
Direct Reporting Line	Reports directly to the Responsible Manager and the relevant Organizational Function.
Indirect Reporting Line	Reports indirectly to the Director of Nursing and Midwifery Services and the relevant Organizational Position.
Cross-functionality	In a multidimensional/multidisciplinary approach, collaborates with all healthcare professionals assisting patients in an outpatient setting at the center.
Third-Sector Engagement	Promotes and interacts with all patient and family associations that work in synergy with the reference center.
Space and Time Management	Organizes spaces and reception modalities for individuals with metabolic and/or endocrine disorders, coordinating with the team to ensure that all clinical, care, and social health activities are conducted according to LM principles.
Tools	Utilizes all available tools to promote multidisciplinary and interdepartmental integration (shared medical record and/or electronic supports).
Clinical Care and Social Health Macro-Area
Major Interventions During Nursing Assessment	-Arrange spaces and environments to provide the best reception for the patient, their family, and their community from an LM perspective. -Observe signs and symptoms expressed by the patient or their family, identifying LM needs. -Encourage the patient, family, or community to voice their concerns and seek help. -Collect anamnesis and clinical data, assessing the care priorities for the patient, family, or community. -Measure vital signs and identify the patient’s needs from an LM perspective. -Assess the resources available to the patient, family, and community in terms of autonomy to meet LM needs. -Identify the primary caregiver to be involved in the ICP process.
Major Interventions During Nursing Diagnosis and Care Objectives	Analyze the collected data to develop LM nursing diagnoses that address the care needs of patients with diabetes and/or endocrine disorders, as well as their families and communities. Collaborate and integrate with the multidisciplinary team to assess clinical care and social healthcare priorities from an LM perspective.
Major Interventions During Nursing Planning	-Collaborate with the multidisciplinary care team to develop the ICP from an LM perspective. -Facilitate the development of pathways and procedures for continuous LM care in a multidisciplinary approach. -Promote and support the development of specific LM professional standards. -Plan LM therapeutic or diagnostic interventions.
Major Interventions for Nursing Implementation	-Implement the ICP from an LM perspective. -Support the relationship with the patient, their family, and their community through a listening-centered approach, focusing on patients with diabetes and/or endocrine disorders. -Guide and support the patient, their family, and their community through all phases of the ICP. -Perform necessary LM nursing practices for the care and rehabilitation of patients with diabetes and/or endocrine disorders, their families, and their communities, working interdependently. -Foster the development of a supportive network to achieve care objectives. -Interact with the family and community throughout the ICP process. -Implement nursing interventions, defining the necessary time, methods, tools, and material and immaterial resources. -Properly manage clinical care documentation in all its parts and within appropriate timeframes. -Apply company procedures, protocols, and departmental operational instructions. -Review and update the ICP based on the responses of patients with diabetes and/or endocrine disorders, their families, and their communities. -Integrate new care tools, such as technological devices and new communication forms (tele-nursing LM).
Major Interventions During Nursing Evaluation	-Evaluate the ICP as a whole, suggesting possible LM improvement strategies. -Monitor the interventions provided, verifying both direct and indirect outcomes of the care given. -Document the outcomes of interventions using appropriate departmental and corporate communication and information tools. -Suggest possible improvement strategies by evaluating and comparing the planned and actual timelines of the entire LM nursing process for patients with diabetes and/or endocrine disorders, their families, and their communities.
Therapeutic Education and Health Prevention Macro-Area
Major Interventions in Therapeutic Education and Health Prevention	-Develop LM educational–therapeutic programs to promote healthy and conscious lifestyles for patients with eating disorders, as well as for their families and communities. -Identify educational and preventive health needs for patients with diabetes and/or endocrine disorders, as well as for their families and communities. -Identify major risk factors for patients with diabetes and/or endocrine disorders and facilitate the development and implementation of specific primary, secondary, and tertiary prevention programs within the LM framework. -Promote the production of LM informational materials for both individualized educational–therapeutic purposes and community-wide prevention. -Promote individualized nursing care plans according to the principles of LM. -Provide specialist LM nursing consultancy as needed.

Legend: LM: lifestyle medicine; CCNL: National Collective Labor Agreement; CME: Continuing Medical Education; ICP: Individualized Care Plan.

).

4. Discussion

Our study aimed to identify the role and clinical applications of LMCMNs for T2D patients internationally and to analyze the role of specialist nurses in Italy through a narrative review. A secondary objective was to define a JD for a future Delphi method.

The role of the LMCMN is crucial and strategic for improving both technical and emotional compliance with integrated care in a modern and efficient healthcare system. Studies have shown that integrated care strategies that consider the patient as a whole, including through advanced technological organizational models, should be the most common approach for disease management at all levels of care [43,44,45]. This aligns with the findings of our review, which highlight the importance of a nursing care approach to achieve overall improvements in both qualitative and quantitative outcomes, particularly for chronic territorial diseases and T2D. In comparison, other studies have underscored the effectiveness of similar roles in chronic disease management. For instance, research by Abraham et al. [46] found that specialized nursing roles significantly improved patient adherence and clinical outcomes in chronic disease management, paralleling the benefits observed with LMCMNs [16]. Moreover, a study by Woo et al. [47] also demonstrated the positive impact of integrated care models on patient satisfaction and health outcomes, reinforcing the necessity of such roles in the healthcare system.

Our review indicates that policymakers and healthcare professionals should play an active and supportive role for chronic patients, which would bring significant social and community benefits. This is particularly relevant in Italy, where the implementation of appropriate clinical pathways from a lifestyle medicine perspective could strengthen the psychological health of vulnerable individuals, especially at the onset of the disease. Comparing this with international findings, it is evident that countries with well-established community nursing frameworks, such as the UK and Australia, have seen notable improvements in chronic disease management through the integration of specialized nursing roles [48,49]. These findings suggest that Italy could similarly benefit from enhancing the role of specialist nurses within its healthcare system. In particular, the Chronic Care Model (CCM) is gaining attention as a strategy to address the increase in chronic conditions due to the aging population. This model entails a systemic approach to managing chronic diseases, emphasizing the importance of collaboration among different levels of healthcare and the active involvement of patients in managing their own health [50,51]. The CCM has been successfully implemented in other countries, demonstrating significant improvements in chronic disease management. For instance, the model has led to reductions in hospitalization rates and improvements in patient health outcomes in several countries [52]. The integration of LMCMNs into this model could further enhance the effectiveness of the Italian healthcare system, improving the management of T2D and other chronic conditions.

Our study also aimed to define a job description for LMCMNs using a validated Delphi method approach to guide future research [53]. The narrative review highlighted a significant lack of personalized care in sensitive areas, such as community settings, a problem exacerbated by the management challenges that emerged during the COVID-19 pandemic [54,55,56]. The rise in specialist territorial or family nurses in Italy indicates a shift towards more personalized and community-focused care [57,58]. This is in line with the European EnHANCE project, which aims to define a shared training pathway to enhance the competencies of FCNs and establish a competency profile for FCNs as a reference for constructing a European curriculum [59]. This project highlights the importance of continuous professional development and specialized training for nurses, which is essential for the successful implementation of LMCMNs. Consequently, it is worthwhile to consider enabling LMCMNs to enhance their skills for the benefit of the community by creating dedicated training pathways. Increased training and empowerment of these professionals could represent a significant step forward in better managing chronic diseases, promoting a community environment more conducive to integrated and modern care such as lifestyle medicine. Integrating specific lifestyle medicine skills into the FCNs already working in the field could be a practical and immediate solution to address these challenges, contributing to a better quality of life for vulnerable individuals, such as those with T2D and other chronic conditions. Comparatively, similar initiatives in other healthcare systems have demonstrated the efficacy of targeted training programs in improving patient outcomes and professional satisfaction among nurses [60,61]. This reinforces the potential benefits of developing and implementing specialized training pathways for LMCMNs in Italy.

Limitations

This study has several limitations. The primary one is that it is focused exclusively on the Italian healthcare context, although it could be applied to other healthcare systems in both organizational and care aspects. Another notable limitation is the difficulty in finding documents that scientifically analyze the JD from an evidence-based nursing perspective, which nevertheless made this work unique and with potential for growth and expansion to other care settings typical of chronic diseases (e.g., cardiology or oncology). Additionally, this narrative review is limited to clinical roles and does not cover academic training. Certainly, systematic studies could provide stronger support for the preliminary content of this study.

5. Conclusions

This study has highlighted the strategic importance of LMCMNs in improving both technical and emotional compliance in integrated care for T2D. This narrative review underscores how a patient-focused, specialized nursing approach is essential for achieving significant improvements in clinical outcomes and patient satisfaction. Defining a JD for LMCMNs, guided by a future Delphi method, is crucial for effectively implementing nursing care, especially in community settings for patients with T2DM. In Italy, as well as in other European countries, the adoption of appropriate clinical pathways from an LM perspective could strengthen the psychological and physical health of vulnerable patients, particularly at the onset of T2D. Increasing the training and empowerment of LMCMNs represents a fundamental step towards improving the management of chronic diseases, promoting a more efficient and patient-centered healthcare environment. Further research is needed to validate and expand the results of this study. Future studies could explore the specific impact of LMCMNs on different patient populations and healthcare settings, as well as the effectiveness of targeted training programs in improving nurses’ competencies and patient outcomes. By ensuring an evidence-based approach and continuous professional development, the role of LMCMNs can be further optimized to address emerging challenges in the management of T2D and other chronic conditions.