International Diabetes Nursing

Nurses’ perceptions of continuous glucose monitoring in pediatric high-dependency care: a single-center survey of workflow and safety during management of an infant with hyperinsulinemic hypoglycemia

Soo Ting Joyce Lim — 2026-08-28

Background: Dysglycemia is associated with increased morbidity and mortality in critically ill pediatric patients. Continuous glucose monitoring (CGM) offers real-time glucose trend data, addressing limitations of point-of-care (POC) testing, such as intermittent readings and high workload. However, successful implementation of CGM in high-dependency (HD) pediatric care depends significantly on nurses’ perceptions and acceptance, which could better manage nursing workload.

Objective: This study explores nurses’ perceptions of CGM in a pediatric HD setting, focusing on factors that influence CGM adoption for workload management, using a case formulation framework, including predisposing, perpetuating, precipitating, and protective factors.

Methods: A single-center study was conducted at KK Women’s and Children’s Hospital, involving 45 HD nurses who took part in a validated 20-item survey. Training on CGM implementation and guidelines was provided, and descriptive statistics were used to analyze survey responses. A specific case of an infant with hyperinsulinemic hypoglycemia (HH) was included to illustrate CGM’s clinical application. The study was conducted in accordance with institutional guidelines, ensuring confidentiality of patient and nurse data.

Results: Most nurses (86%) reported that CGM was easy to use and reduced their workload compared to POC testing. In addition, 88% of nurses agreed that CGM, when combined with POC testing, enhanced patient safety. Despite limited familiarity with CGM prior to implementation (37% reported no prior experience), 86% of nurses felt comfortable using CGM after training, which was primarily delivered through peer-led handovers. Barriers to adoption included challenges with calibration protocols and perceived accuracy (54% reported CGM readings as accurate). Overall, 82% of nurses recommended CGM for continued use in HD care.

Conclusion: The CGM is perceived positively by nurses for its ability to enhance patient safety, improve workflow efficiency, and reduce workload in pediatric HD settings. However, successful implementation requires structured training, clear guidelines, and ongoing support to address barriers such as limited familiarity and calibration challenges. Future research should evaluate CGM’s cost-effectiveness, clinical outcomes, and long-term impact on glycemic control in acute inpatient pediatric care.

The multigenerational legacy of diabetes, stigma, disclosure, and anxiety during insulin regimen initiation

Melissa Scollan-Koliopoulos — 2026-08-25

Background: Diabetes is a hereditary condition often affecting multiple generations. Preconceived notions of diabetes, its self-management, and consequences are passed down generationally. Stigma formation may occur in families with family members sharing the same internalized or externalized stigma experiences. Stigma is an established mediator of anxiety.

Methods: A diverse sample of hospitalized adults (n = 92) with diabetes in the United States of America who were being initiated onto insulin and had a family history of diabetes were administered paper-and-pencil surveys to ascertain their stigma perceptions, disclosure behavior, and anxiety. Regression analyses were used to estimate the effects of family stigma on one’s own stigma and anxiety levels.

Results: Recollections of insulin shots by family members and stigma perceptions by the family member significantly predict one’s own internalized stigma of diabetes, explaining 47% of the variance in stigma. Family stigma of insulin significantly explained 35% of the variance in one’s co-occurring internalized stigma, which also significantly explained 94% of the variance in disclosure. Internalized stigma due to diabetes was associated with higher levels of anxiety, significantly explaining 33% of the variance in anxiety.

Conclusion: In the context of a multigenerational legacy of diabetes, anxiety may be a consequence of stigma that has been passed down generationally. When family members have a stigma of insulin, along with frequent, strong, vivid, and intrusive memories of their family member using insulin, they are likely to develop a stigma of diabetes themselves. Stigma is a predictor of anxiety. Nurses can tailor psychoeducation interventions that include coping with diabetes and insulin stigma across generations.

The diabetes family social consequences survey: predicting diabetes quality-of-life in the context of insulin-treated multigenerational legacy of diabetes

Melissa Scollan-Koliopoulos — 2026-05-15

Background: Stigma is an important construct that can be shared and recalled by family members affected by diabetes. Stigma and disclosure beliefs are formed and passed down by families in the multigenerational context of diabetes. Insulin is an object of stigma in diabetes treatment, influencing health behavior and quality of life.

Methods: Hospitalized adults in a Northeast Coast Metropolitan area in the United States of America with diabetes who were newly initiated onto insulin were surveyed to assess the validity and reliability of the family social consequences of diabetes treated with insulin. The survey items were factor analyzed and tested for internal consistency reliability. The predictive ability of the survey to assess diabetes-specific health-related quality-of-life was assessed.

Results: The survey identified two highly valid and reliable components that measure recollections of family stigma and family disclosure within the context of insulin use in the multigenerational legacy of diabetes. Family stigma explained 59% variance, and family disclosure explained 70% variance. The survey significantly predicted diabetes-related health quality of life (R² = 0.35, P = 0.02) with family stigma contributing uniquely to explaining variance in quality-of-life scores.

Conclusion: Family stigma and disclosure are measurable constructs capable of predicting quality of life. In the presence of recollections of family stigma and disclosure of insulin use, individuals experience sub-optimal health-related quality of life. Nurses and diabetes educators can assess the impact of family experiences on health outcomes.

Effects of a shared decision-making guide tool on confidence in diabetes management using continuous glucose monitoring among diabetes nurses: a randomized controlled trial

Yaeko Kawaguchi — 2026-03-05

Background: Shared decision-making (SDM) between patients and their healthcare professionals in developing treatment plans is increasingly recognized as central to improving treatment adherence and, ultimately, patient outcomes. This study investigated the effects of a SDM guide tool on confidence in diabetes management using continuous glucose monitoring (CGM) among diabetes nurses.

Methods: Twenty-seven diabetes nurses were randomly assigned to either an intervention group or a control group. Participants in both groups received a 60-min basic course on CGM. Participants in the intervention group underwent a 90-min advanced course using a SDM guide tool. Confidence (13 items), attitude (11 items), knowledge (16 items), and consultation style (5 items) were assessed at baseline and 1 month after the intervention. Evaluation of the tool (13 items) was assessed in the intervention group.

Results: Compared to the control group, the intervention group had greater changes in confidence score after the intervention (1.4 ± 1.5 vs. 2.6 ± 1.5 points; P < 0.001). There were no significant changes in the attitude, knowledge, and consultation style scores between the groups. The evaluation score with the tool was relatively high.

Conclusion: This program using a SDM guide tool may be effective in increasing confidence in diabetes management using CGM among diabetes nurses.

Medication adherence, health-related quality of life, and hospital readmission outcomes of a diabetes transitional care intervention

Melissa Scollan-Koliopoulos — 2026-03-19

Background: The time between hospital discharge and follow-up medical care is a time that often leaves people with diabetes without the support necessary to ensure medication adherence and assistance with determining when emergency care may be appropriate. The I-Care-4-Health Transition intervention was developed to reduce hospital readmissions.

Methods: A quasi-experimental intention-to-treat design was employed to evaluate a transitional care intervention in a Northeast Coast hospital in the United States of America, initiated during the initial hospital stay and continued for 6 months following hospitalization. The intervention adapted components of leading transitional care interventions. It was delivered to n = 86 people with diabetes by healthcare technicians serving in a navigational role with an advanced nurse practitioner-led team, which also included hospital nurses and physicians. Scripted talking points on red flag symptom instructions and medication adherence were delivered on scheduled telephone calls.

Results: Significant improvements were noted in medication adherence (t = 3.77, p < 0.001) and health-related quality of life (HRQOL) (t = 3.04, p = 0.003), with medication adherence predicting HRQOL at program completion (F = 8.37, p = 0.005). Medication side effects accounted for 42% of the variance in HRQOL, and suboptimal adherence was associated with hospital admissions (F = 4.5, p = 0.04). The readmission rate was 22% for the sample.

Conclusion: Team-based care can include technician-level navigators working under the supervision of advanced practice nurses to provide continuous, across-setting support through scheduled telephone calls, beginning during hospitalization and continuing after hospital discharge. The I-Care-4-Health Transitions project improved medication adherence and HRQOL in individuals with diabetes from low-income backgrounds and can ensure appropriate and timely emergency department use to prevent 30-day all-cause readmissions.

A systematic review of group-based psychosocial interventions for adolescents with Type 1 diabetes

Shenelle Wickramarathna — 2026-09-09

Background: Adolescence is a challenging developmental period, marked by increased autonomy and reduced parental support. For adolescents with Type 1 diabetes (T1D), this often coincides with a sharp decline in glycaemic control and increased psychological burden. Group-based psychosocial interventions aim to improve coping skills, resilience and diabetes-related problem-solving, supporting adolescents as the transition towards independent self-management. We aimed to systematically review existing group psychosocial interventions for young people with T1D, and identify effective mechanisms of action.

Method: A systematic review of six databases yielded 5,259 records, of which 22 studies were eligible for inclusion. Narrative and tabular synthesis were used to describe the interventions, their underpinning theories, active mechanisms, delivery models, and reported outcomes.

Results: Six broad types of group-based psychosocial interventions were identified, cognitive behavioural/stress-management, guided self-determination for youth, psychoeducational, self-efficacy/social-cognitive, mindfulness/acceptance, and motivational/solution-focused approaches. Across studies, at least two of the nine core active techniques were consistently applied, including goal setting, problem-solving, cognitive behavioural strategies, communication training, relaxation, family teamwork, and diabetes education. Reported outcomes were heterogeneous: modest improvements were most commonly seen in psychosocial parameters (e.g. depression, diabetes distress, family functioning, self-efficacy), while effects on clinical and behavioural outcomes were mixed.

Conclusion: Group-based psychosocial interventions for adolescents with T1D show potential, particularly in improving psychosocial wellbeing, but evidence is limited by small sample sizes, variable quality, and inconsistent reporting. Standardisation of intervention components and outcome measures, alongside larger, high-quality trials, is needed to guide effective practice.