Open research questions in Diabetes Management and Education

What the literature leaves open

• Despite the critical role of dietitians in managing chronic diseases, there is limited research on how their services are accessed and valued within private healthcare systems – es- pecially in regions like Dubai, where insurance and referral practices vary (4). Most existing studies focus on public systems, leaving a gap in understanding access dynamics in privatized ambulatory care (5, 6).

  Direct Access to Dietitian Services in Dubai's Private Ambulatory Care: Multi-Stakeholder Insights and Implications for Chronic Disease Management. · 2026 · DOI

• Aim This study compared glycemic control and diabetes distress in individuals with type 1 diabetes using automated insulin delivery (AID) systems versus those not using such systems, addressing a gap in research on psychosocial outcomes of diabetes technologies.

  Comparison of AID users and non-users regarding glycemic control and diabetes distress: A mixed-methods study · 2026 · DOI

• Further research is needed to explore the generalizability of our results to other health care systems, including more diverse populations, and to examine longer- term outcomes and link differences in outcomes to the specific interventions received. Augustine, “Adoption of Clinical Risk Prediction Tools Is Limited by a Lack of Integration With Electronic Health Records,” BMJ Health & Care Informatics 28, no.

  Effect of Using Personalized Estimates of Diabetes Risk During Primary Care Visits for People With Prediabetes · 2026 · DOI

• Puskesmas Sindangkerta is recommended to optimize the implementation of Prolanis by implementing a WhatsApp-based reminder system, periodic education using simple media such as videos and leaflets, as well as exploring online activities for patients with limited access. Health workers are expected to increase active communication and follow-up with patients who are inactive or have not yet achieved blood sugar control targets. Educational institutions can contribute through community service activities supporting promotive and preventive programs for chronic diseases. ACKNOWLEDGMENTS The authors would like to express gratitude to the Head of Puskesmas Sindangkerta, STIKes Budi Luhur Cimahi, the supervising lecturers, and all parties who have contributed to the completion of this research. REFERENCES American Diabetes Association. (2023). Introduction and Methodology : Standards of Care in Diabetes — 2023. 46(December 2022), 1–4. https://doi.org/10.2337/dc23-Sint American Diabetes Association. (2024). Introduction and Methodology : Standards of Care in Diabetes — 2024. 47(January), 1–4. https://doi.org/10.2337/dc24-SINT Atto’illah, M. A., Anggraini, M. T., Lahdji, A., & Anggraheny, H. D. (2021). Keaktifan Mengikuti Prolanis Mempengaruhi Kestabilan Tekanan Darah pada Pasien Hipertensi di Puskesmas Warungasem Activeness of Prolanis Participation Influencing the Blood Pressure Stability tar. 3(2). in Hypertension Patients at Public Health Center Warungasem https://doi.org/10.26714/medart.3.2.2021.75-86 Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan. (2022). Panduan praktis Prolanis (Program pengelolaan penyakit kronis). Badan Penyelenggara Jaminan Sosial (BPJS). https://unitkesehatan.ipb.ac.id/wp-content/uploads/2022/07/PANDUAN-PROLANIS.pdf Dinas Kesehatan Provinsi Jawa Barat. (2024). Jumlah Penderita Diabetes Melitus di Provinsi Jabar.

  The Relationship Between Prolanis Participation and Blood Sugar Control Among Type 2 Diabetes Mellitus Patients at Puskesmas Sindangkerta · 2026 · DOI

• Although continuous glucose monitors (CGMs) improve glycemic control, benefits often plateau after early adoption, and evidence is limited regarding post-initiation CGM-focused interventions.

  A Spanish-language educational intervention to enhance diabetes outcomes among existing continuous glucose monitor users in a federally qualified health care center · 2026 · DOI

• Voucher redemption rates varied widely across participants, indic- ating substantial heterogeneity in program engagement; this vari- ability may limit the precision of estimated predictors.

  Predictors of Voucher Redemption in Produce Prescription Programs in a Primarily Low-Income Population With Type 2 Diabetes · 2026 · DOI

• Data availability statement These results were limited by several important factors. The program only utilized two pilot sites, one from each healthcare system, and the total number of patients, 10, was small which hinders generalizability of these findings. This pilot study is exploratory and was not powered to detect modest differences in baseline characteristics between participants in the intervention and those who declined enrollment. Given the reliance of subjective data from site coordinators regarding the reasons for declining participation, there was also an inability to assess the communication skills or strategies utilized by staff that contacted patients for the study. Although the pilot sites differed in terms of healthcare system characteristics, the sites are both located in the Chicago metropolitan area. Rural populations, which utilize telehealth more frequently, were not included, and future structured virtual group-based DSME studies may benefit from implementation in these settings. The sessions and materials were all in English, which limited participation to English-speaking patients. This was a pilot study with limited resources and we did not have the capacity to implement a multilingual intervention but this represents an important limitation, particularly given that the participating FQHC serves a substantial Hispanic/Latino patient population. The exclusion of non- English speaking patients may limit the generalizability of findings while potentially overlooking specific barriers and facilitators to participation. To address this limitation, the upcoming cluster ran- domized controlled trial has materials and intervention delivery to include Spanish-speaking patients. This limitation is relevant in virtual DSME because language access may influence digital engagement and trust in care delivery. For this pilot project, we conducted qualitative assessment of participant experiences and an assessment of implemen- tation factors, but we did not evaluate clinical outcomes.

  Implementing virtual diabetes self-management education in two health systems (VIDA): a mixed-methods pilot study · 2026 · DOI

• Our study has several strengths: a) the cohort from this pragmatic real-world observational study is likely to be more representative of the target population than one recruited to a more costly and time-consuming RCT, and is less prone to be affected by control group contamination through MWD’s Massive Open Online Courses and other online content; b) the inclusion of a carefully selected, prospectively studied matched control group, along with extensive covariate adjustment, allowed for stronger causal inferences regarding risk factor changes attributed to MWD use; c) sensitivity analyses demonstrated the robustness of our main findings; d) our economic analysis adhered to national decision-making standards based on NICE guidance, [12] exploring effects across different patient populations and estimating time-path trajectories using published equations rather than assuming linear relationships. PLOS One | https://doi.org/10.1371/journal.pone.0349232 June 25, 2026 11 / 15 Our study limitations are: a) the observational design, rather than an RCT, limits causal inference; b) the follow-up of up to 2 years restricts assessment of long-term MWD effects; c) the COVID-19 pandemic may have influenced health behaviours, and limited GP practice engagement (now mitigated by a streamlined NHS login); d) early adopters may be more motivated and health-conscious than non-users; e) the study was limited to people with T2D in Greater Manchester, requiring evaluations of other geographical areas and those living with type 1 diabetes; f) limited statistical power reduced the robustness of interaction and sub-group analyses; g) data on MWD usage/participant engagement was not collected, limiting our ability to assess the impact of motivation and sustained use on effectiveness; h) the health economics anal- ysis was limited by: 1) the absence of a probabilistic sensitivity analysis (this was not computationally feasible), which limits assessment of parameter uncertainty; 2) having a base-case assumption that as people die new people join – an open cohort would be ideal but cannot be achieved with the UKPDS outcomes model; [15] 3) using the UKPDS outcomes model [10, 11] based on an older cohort that did not use newer drug classes; [16] and, 4) reliance on short-term data with- out knowing long-term treatment effects and/or costs.

  Clinical and cost-effectiveness of the digital intervention, MyWay Diabetes, in people with type 2 diabetes living in Greater Manchester during the COVID-19 pandemic · 2026 · DOI

• By including 36-month follow-up data, this study adds valuable evidence on long-term glycemic trajecto- ries within this under-studied context, where real-world evaluations of diabetes management platforms in TCM hospitals remain limited.

  Long-term glycemic outcomes of a diabetes management platform in a traditional Chinese medicine hospital: a real-world retrospective observational study · 2026 · DOI

• 538) models yielded negative R2 values, indicating that emotional intelligence sub-dimensions alone were insufficient to generate meaningful predictions.

  The Role of Emotional Intelligence in Diabetes Management: Evaluating Predictive Power for Self-Care Behaviors Using Artificial Intelligence Models · 2026 · DOI

• However, evidence remains limited regarding how users interpret CGM data and apply it to lifestyle decisions, particularly in low- and middle-income countries Objective: This study explored the experiences of non-diabetic adults in Indonesia using CGM.

  INTERPRETING CONTINUOUS GLUCOSE MONITORING DATA IN NON-DIABETIC INDONESIANS: A PHENOMENOLOGICAL STUDY OF MEANING-MAKING AND LIFESTYLE DECISIONS · 2026 · DOI

• To our knowledge, this is the first systematic review and meta-analysis to document the prevalence of microvascular and macrovascular diabetes complications in adult Ugandans with diabetes. The studies were conducted in different regions of Uganda, improving the generalisability of the results of the systematic review and meta-analysis. Despite these strengths, the systematic review and meta-analysis had some limitations. Some of the included studies used self-reporting as the basis for diagnosing the chronic diabetes complication of interest. This is subject to recall bias and reporting imprecise results. There was considerable heterogeneity in the study sample sizes, study findings, possibly due to the differences in screening procedures, study definitions for the complications of interest, and study settings (pub- lic vs. private healthcare facilities). The studies included in this systematic review and meta-analysis were of low-quality rating, with some studies missing important sociodemographic and clinical characteristics.

  Prevalence and factors associated with microvascular and macrovascular diabetes complications in adult Ugandans: A systematic review and meta-analysis · 2026 · DOI

• The cross-sectional design of this study does not allow for drawing conclusions about causation. Being a facility-based study necessitates making reservations about generalizing the findings to the wider population of all patients with T1D. Since the patient cohort was drawn from a single clinical site it may not fully represent the diverse characteristics of the broader T1D population, such as varying disease management strategies, socioeconomic backgrounds, or access to different levels of healthcare. Therefore, while the findings are robust for the studied population, they should be interpreted with caution when considering their applicability to the general T1D community. The data about all of the variables, including clinical data, was self-reported by the participants and thus prone to reporting bias. Additionally, some participants, especially those who had difficulties in reading, were assisted by the data collectors. Furthermore, certain clinical variables that may be relevant to diabetes-related stigma, such as BMI, diabetes-related complications, and hospitalization history, were not collected and therefore could not be examined, which limits the comprehensive- ness of the clinical picture.

  Diabetes-related stigma among individuals with type 1 diabetes in Jazan, Saudi Arabia: sociodemographic and clinical correlates · 2026 · DOI

• 1 Strength and limitation This study employed an explanatory sequential design to comprehensively examine how psychosocial, behavioral, and finan- cial factors are associated with poor glycemic control. However, this study used a convenience sample of patients with type 2 diabetes attending follow-up clinics, which may not be representative of the broader diabetic population across the hospitals and other levels of care in the country.

  Glycemic control and association with diabetes-related distress, self-management behavior, financial toxicity, and cost-related non-adherence: a mixed-methods study · 2026 · DOI

• inherent to this methodology is that it does not assess the quality of individual studies; however, it provides a comprehensive overview of the field and a foundation for future research development. investigation. A Authors’ contribution: Funding acquisition: GMN. Project administration: GMN. Conceptualization: GMN. Literature search: GMN, VT, GMK and LP. Writing – original draft: GMN. Writing – review & editing: GMN, VT, GMK, DS, ETN, LP and KP. Validation: GMN, VT, GMK, DS, ETN, LP and KP.

  Economic, Political and Social Factors Influencing the Well-Being of Migrants Living with Type 2 Diabetes in Canada: A Scoping Review Protocol · 2026 · DOI

• This study has several limitations. First, because of its cross- sectional design, causal relationships among social support, health literacy, and HbA1c level cannot be established. Second, although participants were recruited from multiple hospitals, convenience sampling and voluntary participation may have introduced selec- tion bias, which could affect the generalizability of the findings. Third, while social support and health literacy were significantly associated with HbA1c, they did not fully explain glycemic control, suggesting that other important determinants—such as treatment- specific knowledge, medication adherence, dietary management, physical activity, self-management capacity, and healthcare-access factors—were not captured. Fourth, variation in HbA1c results may have occurred because of differences in laboratory equipment across hospitals. Finally, because glycemic control changes over time, future longitudinal studies incorporating a broader range of behav- ioral and treatment-related variables are needed to better clarify the in rural patients mechanisms underlying HbA1c control with diabetes.

  The mediating role of health literacy in the relationship between social support and glycemic control among rural patients with diabetes in Western China: a cross-sectional SEM study · 2026 · DOI

• The integrated treatment framework combining psychological interventions with metabolic management for depression and T2DM comorbidity lacks specification regarding implementation protocols in primary health care settings. Research is needed on translating HPA axis and BDNF-targeted interventions into practical primary care workflows across different healthcare systems.

  Unveiling the relationship of the comorbidity between depression and type 2 diabetes mellitus: a macro analysis and micro interpretation · 2026 · DOI

• The HPA axis and BDNF are identified as prominent research hotspots in depression and T2DM comorbidity, but the paper does not specify which mechanisms within these pathways remain mechanistically unclear or require experimental validation in comorbid populations specifically.

  Unveiling the relationship of the comorbidity between depression and type 2 diabetes mellitus: a macro analysis and micro interpretation · 2026 · DOI

• The reciprocal intervention model for depression and T2DM comorbidity—regulating metabolic status through psychological intervention or alleviating emotional disorders through blood glucose control—requires high-quality evidence through cross-border collaborative trials. Specific clinical trial designs testing this bidirectional treatment approach across different healthcare systems remain underdeveloped.

  Unveiling the relationship of the comorbidity between depression and type 2 diabetes mellitus: a macro analysis and micro interpretation · 2026 · DOI

• Bibliometric tools currently lack the capability to differentiate between author names with identical abbreviations in depression and T2DM comorbidity studies. Developing disambiguation algorithms specifically trained on medical literature author datasets would improve accuracy of author contribution tracking and citation analysis in this research domain.

  Unveiling the relationship of the comorbidity between depression and type 2 diabetes mellitus: a macro analysis and micro interpretation · 2026 · DOI

• The bibliometric analysis was constrained by technical limitations preventing simultaneous analysis of multiple databases for depression and T2DM comorbidity research. Future investigations should develop integrated multi-database analysis protocols to capture a more comprehensive literature landscape and reduce the risk of overlooking outstanding papers in this field.

  Unveiling the relationship of the comorbidity between depression and type 2 diabetes mellitus: a macro analysis and micro interpretation · 2026 · DOI

• A previous study in Jazan did not publish the type of CAM used by diabetic patients because the purpose of their study was to evaluate the pattern and reason for using CAM as well as perceptions of the safety and effectiveness.

  KNOWLEDGE, ATTITUDE, AND PRACTICE OF COMPLEMENTARY AND ALTERNATIVEMEDICINE USAGE AMONG PATIENTS WITH TYPE II DIABETES MELLITUS INEASTERN PROVINCE, SAUDI ARABIA2022-2023 · 2024 · DOI

• In further investigations, none of the previous papers managed to investigate the link between attitudes toward CAM among the sociodemographic variables and knowledge. Thus, our findings provided initial insight for further studies.

  KNOWLEDGE, ATTITUDE, AND PRACTICE OF COMPLEMENTARY AND ALTERNATIVEMEDICINE USAGE AMONG PATIENTS WITH TYPE II DIABETES MELLITUS INEASTERN PROVINCE, SAUDI ARABIA2022-2023 · 2024 · DOI

• BACKGROUND: Although scientific reports increasingly document the negative impact of inadequate health literacy on health-seeking behaviors, health literacy's effect on health outcomes in patients with diabetes is not entirely clear, owing to insufficient empirical studies, mixed findings, and insufficient longitudinal research.

  Health Literacy and Outcomes of a Community-Based Self-Help Intervention · 2020 · DOI

• Inductive analysis produced five themes: (i) nutrition care is preferable to pharmacological intervention; (ii) patients report taking action for behaviour change; (iii) healthcare providers experience barriers to nutrition care; (iv) healthcare providers tend not to refer patients for nutrition care; and (v) there are contradictory findings around provision and receipt of nutrition care.

  Understanding the knowledge, attitudes and practices of providing and receiving nutrition care for prediabetes: an integrative review · 2019 · DOI

Most-cited papers in Diabetes Management and Education

• Prevalence of Gastrointestinal Symptoms Associated With Diabetes Mellitus · Archives of Internal Medicine · 2001 · 518 citations
• Prospective Study of Social and Other Risk Factors for Incidence of Type 2 Diabetes in the Whitehall II Study · Archives of Internal Medicine · 2004 · 299 citations
• Bidirectional Association Between Depression and Type 2 Diabetes Mellitus in Women · Archives of Internal Medicine · 2010 · 293 citations
• Management of Chronic Disease by Patients · Annual Review of Public Health · 2003 · 200 citations
• Computer-assisted intervention improves patient-centered diabetes care by increasing autonomy support. · Health Psychology · 2007 · 146 citations
• Diabetes Burden and Diabetes Distress: the Buffering Effect of Social Support · Annals of Behavioral Medicine · 2014 · 145 citations
• Characteristics of self-care interventions for patients with a chronic condition: A scoping review · International Journal of Nursing Studies · 2020 · 143 citations
• Validity and Reliability of an Adolescent and Parent Rating Scale of Type 1 Diabetes Adherence Behaviors: The Self-Care Inventory (SCI) · Journal of Pediatric Psychology · 2009 · 135 citations
• Diabetes self-management among low-income spanish-speaking patients: A pilot study · Annals of Behavioral Medicine · 2005 · 121 citations
• The role of patient, physician and systemic factors in the management of type 2 diabetes mellitus · Family Practice · 2002 · 120 citations

Most recent work

• From language matters to stigma‐free communication in diabetes: Evolution, challenges, and next steps · Diabetic Medicine · 2026
• Neuropatía diabética y su relación con la calidad de vida en pacientes con diabetes tipo 2 · Atención Primaria · 2026
• Prevalence and determinants of diabetes-related psychological distress in a tertiary care setting in Tamil Nadu, India: cross-sectional study – CORRIGENDUM · BJPsych Open · 2026
• Glycemic control and association with diabetes-related distress, self-management behavior, financial toxicity, and cost-related non-adherence: a mixed-methods study · Frontiers in Endocrinology · 2026
• A Brief Occupational Therapy Foot Care Program for Community-Dwelling Older Adults and the Social Connectedness Implications · Occupational Therapy In Health Care · 2026
• Effect of Using Personalized Estimates of Diabetes Risk During Primary Care Visits for People With Prediabetes · Learning Health Systems · 2026
• Unveiling the relationship of the comorbidity between depression and type 2 diabetes mellitus: a macro analysis and micro interpretation · Frontiers in Medicine · 2026
• Primary care providers’ perspectives on the implementation of couple-based collaborative management for Chinese older adults with type 2 diabetes: a mixed-methods study · Frontiers in Public Health · 2026
• Community-based Interventions for the Prevention of Diabetes and Hypertension: A Population Health Perspective · Journal of Medicine and Health Research · 2026
• Long-term glycemic outcomes of a diabetes management platform in a traditional Chinese medicine hospital: a real-world retrospective observational study · Frontiers in Endocrinology · 2026

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