Effectiveness of a Nurse-Led Educational Program on Medication Adherence and Glycemic Control in Adults with Type 2 Diabetes Mellitus: A Quasi-Experimental Study

Abstract

Background: Type 2 diabetes mellitus (T2DM) is a leading cause of preventable morbidity in Iraq, and medication non-adherence is a known driver of poor glycemic control in the region. Evidence on structured nurse-led educational interventions in Iraqi outpatient diabetes clinics is limited. Aim: To evaluate the effectiveness of a six-week nurse-led structured educational program on medication adherence, glycemic control, self-care behaviors, and disease knowledge in Iraqi adults with T2DM. Methods: A two-arm pre-post quasi-experimental study was conducted between August 2025 and February 2026 in the diabetes outpatient clinics of two Iraqi teaching hospitals (Salah Al-Din General Teaching Hospital and Baghdad Teaching Hospital), reporting in line with the TREND statement [1]. The protocol was prospectively registered (ATU-RIR-2025-08, registered 22 July 2025). Adults aged 30–70 years with HbA1c ≥7.5% on ≥6 months of oral antidiabetic therapy were enrolled by alternating allocation (160 enrolled; 144 completed [90.0%]; intervention n = 73, control n = 71). The intervention comprised six weekly nurse-led 60-minute group sessions covering disease pathophysiology, medication management, self-monitoring, diet, physical activity, foot care, and complication screening, supplemented by an Arabic patient handbook and weekly telephone follow-up. Controls received routine monthly clinic visits. Outcomes—Morisky Medication Adherence Scale-8 (MMAS-8), HbA1c, Diabetes Knowledge Test-2 (DKT-2), and the Summary of Diabetes Self-Care Activities (SDSCA)—were measured at baseline and at week 12. Analyses used ANCOVA adjusted for baseline values, age, and sex, with intention-to-treat principles and 4.4% missing data handled by multiple imputation. Results: Groups were balanced at baseline. At week 12, HbA1c fell from 9.4 ± 1.3% to 8.1 ± 1.2% in the intervention arm and from 9.3 ± 1.2% to 9.0 ± 1.4% in controls (adjusted between-group difference −1.0%, 95% CI −1.4 to −0.6, p < 0.001). MMAS-8 score increased by 1.8 (95% CI 1.4–2.2) in the intervention arm vs 0.3 (95% CI −0.1 to 0.7) in controls (between-group p < 0.001). DKT-2 knowledge scores improved by 27.4% in the intervention arm vs 4.1% in controls. SDSCA self-care scores improved significantly for diet, exercise, and foot care in the intervention arm only. Conclusion: A structured six-week nurse-led educational program was associated with clinically meaningful improvements in glycemic control, medication adherence, knowledge, and self-care in Iraqi adults with T2DM. The program is low-cost and deliverable within existing outpatient nursing infrastructure, and warrants larger replication with longer follow-up to assess durability and effect on diabetes-related complications.