Enhanced Nursing Intervention, Glycemic Variability, And In-Hospital Outcomes In Type 2 Diabetes Mellitus: A Retrospective Cohort Study

Summary

This retrospective propensity score-matched study of 100 patients with type 2 diabetes mellitus found that enhanced nursing intervention reduced glycemic variability and improved short-term in-hospital outcomes compared with usual care.

Abstract

This study investigated the association between enhanced nursing intervention and glycemic variability, as well as short-term hospitalization outcomes, in patients with type 2 diabetes mellitus (T2DM). A retrospective cohort design was employed, consecutively enrolling hospitalized patients with T2DM from December 2022 to December 2025. Propensity score matching (1:1) was performed to balance age, sex, disease duration, and baseline medication use, resulting in 50 patients receiving enhanced nursing care and 50 receiving routine care. Enhanced nursing included dietary and exercise guidance, psychological counseling, self-management education, and continuous glucose monitoring. Primary outcomes included glycemic variability metrics, including standard deviation of blood glucose, mean amplitude of glycemic excursions, largest amplitude of glycemic excursions, coefficient of variation, and time in range. Secondary outcomes included hospitalization parameters, including length of stay, readmission rate, hypoglycemic events, and nursing satisfaction. After matching, baseline characteristics were comparable between groups. Compared with the routine care group, the enhanced nursing group demonstrated significantly lower glycemic variability indicators and reduced fasting and postprandial glucose levels (p < 0.05). Hospitalization outcomes also improved significantly, including shorter length of stay (p < 0.05), lower 30-day readmission rate (2.0% vs. 14.0%, p = 0.027), and fewer hypoglycemic events (6.0% vs. 24.0%, p = 0.012). Multivariate regression analysis identified enhanced nursing as an independent protective factor associated with reduced glycemic variability (B = −7.892, p < 0.001) and shorter hospitalization duration (B = −3.112, p < 0.001). These findings suggest that enhanced nursing intervention is associated with improved glycemic stability and better short-term hospitalization outcomes in patients with T2DM.

Introduction

Type 2 diabetes mellitus (T2DM) is a common metabolic disorder with a continuously increasing global prevalence^1,2,3. According to recently published data from the International Diabetes Federation, China has the highest number of adults affected by diabetes worldwide, with T2DM accounting for >90% of cases^4,5. Clinical assessment of glycemic control has traditionally relied on glycated hemoglobin as the gold standard because it reflects average blood glucose levels over the preceding 2 to 3 months

Protocol

This retrospective observational study was approved by the Ethics Committee of Beijing Rehabilitation Hospital Affiliated to Capital Medical University (approval number: 2026-A-022). The study was conducted in accordance with the Declaration of Helsinki and relevant Chinese regulations governing biomedical research involving human subjects. Because the study used retrospectively collected, de-identified clinical data obtained during routine medical care, the ethics committee granted a waiver of informed consent. All patient data were anonymized before analysis, and no personally identifiable information is reported in this study. The study involved no experimental int....

Results

Baseline Characteristics After PSM

After PSM, baseline characteristics were balanced and comparable between the two groups (Table 1). All patients in the routine care group received standard inpatient diabetes management, including vital sign monitoring, medication administration, blood glucose monitoring, routine health education, and discharge instructions without active post-discharge follow-up. In addition to routine care, patients in the enhanced nursing .......

Discussion

This retrospective study of 50 propensity score-matched patients with T2DM evaluated the association between enhanced nursing intervention and glycemic variability indicators. The enhanced care group demonstrated significantly improved glycemic variability parameters, shorter hospital stay, fewer hypoglycemic events, lower readmission rates, and higher nursing satisfaction compared with the routine care group. Multivariable regression analysis further identified the enhanced nursing model as an independent protective fac.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
AiXin Health APP	Sinocare Inc., Changsha, China	Version 3.2.1	Mobile application for continuous glucose monitoring data display, alarm management, and glucose-data export RRID: N/A
Electronic medical record system	Institutional hospital information system	N/A	Used for retrieval of demographic, laboratory, medication, and nursing documentation data RRID: N/A
GAD-7 scale	American Psychiatric Association	N/A	Seven-item anxiety assessment questionnaire used for psychological screening; score range 0–21 RRID: N/A
G*Power	Heinrich-Heine-Universität Düsseldorf, Germany	Version 3.1	Statistical power and sample-size calculation software RRID: SCR_013726
Hitachi 7600-110 automatic biochemical analyzer	Hitachi, Ltd., Tokyo, Japan	7600-110	Used for fasting plasma glucose, glycated hemoglobin, lipid profile, and liver/kidney function testing; daily calibration and quality-control procedures applied RRID: N/A
iglu R package	Broll et al.	Version 3.0.0	Used for calculation of glycemic variability metrics including MAGE, CV, LAGE, and TIR RRID: N/A
Insulin pen	Novo Nordisk, Bagsværd, Denmark	NovoPen 4	Used for subcutaneous insulin administration RRID: N/A
MatchIt R package	Ho et al.	Version 4.5.0	Used for propensity score matching RRID: SCR_025618
Medtronic Paradigm insulin pump	Medtronic, Northridge, CA, USA	MMT-712EWS	Continuous subcutaneous insulin infusion system; infusion sets replaced every 48 h RRID: N/A
Minnesota Satisfaction Questionnaire (MSQ) Nursing Version	Adapted from Weiss et al. (1967)	N/A	Twenty-item nursing satisfaction questionnaire with intrinsic, extrinsic, and general satisfaction domains RRID: N/A
OK Pro blood glucose monitoring system	Xunying Optoelectronics Co., Ltd., Taiwan, China	OK-Pro-C01	Fingertip blood glucose monitoring system; electrochemical biosensor; measurement range 0.3–38.9 mmol/L RRID: N/A
R statistical software	R Foundation for Statistical Computing, Vienna, Austria	Version 4.2.1	Statistical analysis and continuous glucose monitoring data preprocessing RRID: N/A
Sinocare iCan CGM System (Second Generation)	Sinocare Inc., Changsha, China	i3	Continuous glucose monitoring system with 3 min sampling interval, factory calibration, and 15 day wear duration RRID: N/A
SPSS Statistics	IBM Inc., Armonk, NY, USA	Version 26.0	Statistical analysis software RRID: SCR_016479
Tosoh G8 HbA1c analyzer	Tosoh Bioscience, Tokyo, Japan	G8	High-performance liquid chromatography analyzer for glycated hemoglobin measurement RRID: N/A
Warm Heart Box (hypoglycemia emergency kit)	Institutional preparation	N/A	Contains glucose tablets, candies, juice, and crackers for hypoglycemia self-management RRID: N/A