Digital Self-Management Education and Support for Young Adults With Type 2 Diabetes (DSMESYAT2DM)

Young adults with Type 2 Diabetes Mellitus (T2DM) face unique challenges related to lifestyle, work, social life, and adherence to treatment recommendations. Many patients in this age group have difficulty sustaining diabetes self-management behaviors, achieving glycemic targets, and coping with diabetes-related emotional burden. Digital health technologies offer new opportunities to provide flexible, individualized, and continuous self-management education and support. However, there is still limited evidence on structured, nurse-led digital Diabetes Self-Management Education and Support (DSMES) programs specifically designed for young adults with T2DM.

This study is a single-center, parallel-group, randomized controlled trial designed to evaluate the effectiveness of a nurse-led digital DSMES program on self-management behaviors, glycemic control, and diabetes-related distress in young adults with T2DM. The study will be conducted in the Endocrinology and Metabolism outpatient clinic of Van Regional Training and Research Hospital.

A total of 72 participants aged 18 to 45 years with a diagnosis of T2DM will be included. Eligible patients will be literate, have access to the internet and a digital device (such as a smartphone, tablet, or computer), and will not have communication barriers or major physical or mental conditions that prevent participation. Patients with Type 1 diabetes, gestational diabetes, or advanced visual impairment (for example, severe diabetic retinopathy with significant vision loss) will be excluded. After obtaining informed consent, participants will be stratified by baseline HbA1c level (for example, 6.5-9% and >9%) and then randomly assigned to either the intervention group or the active control group in a 1:1 ratio (36 participants per group). The randomization will be computer-based and performed by a researcher who is not involved in outcome assessment.

The intervention group will receive a 12-week nurse-led digital DSMES program delivered through a web-based and/or mobile digital platform. The content of the program will be structured according to the ADCES7™ self-care behaviors (healthy eating, being active, taking medication, monitoring, reducing risks, healthy coping, and problem solving). The program will include:

digital educational modules presented in text, visual, and/or video formats, tools for self-monitoring of blood glucose and other relevant parameters, individualized goal-setting and progress-tracking features, reminders and motivational messages, interactive communication with a diabetes nurse via messaging or other digital communication functions, and referral or consultation with other members of the multidisciplinary team (such as a dietitian or physician) when necessary.

The nurse will follow a structured protocol for providing education, answering questions, reinforcing self-management behaviors, and supporting problem solving and coping during the 12-week intervention period.

The active control group will receive usual diabetes care provided by the clinic and access to standard digital written diabetes education materials through the same platform. This may include nationally approved patient education brochures for T2DM (for example, the Ministry of Health Type 2 Diabetes Mellitus patient education brochure in PDF format). Control group participants will also be able to enter and view their basic self-monitoring data (such as blood glucose values), but they will not receive the structured, nurse-led DSMES intervention, interactive counseling, or tailored motivational support.

Outcome assessments will be conducted at baseline and at the end of the 12-week intervention period. Primary outcomes will include changes in diabetes self-management behaviors and glycemic control, assessed using a validated Type 2 diabetes self-management scale and laboratory measures such as HbA1c and blood glucose values obtained from hospital records. Secondary outcomes will include changes in diabetes-related distress, measured with a validated diabetes distress scale, and user experience with the digital program, assessed with a mobile or digital application usability scale. Sociodemographic and clinical data will also be collected using standardized forms.

The study is planned as a single-blind design, in which participants are not informed of the specific group allocation (intervention versus active control), although they may recognize differences in the intensity of the digital support they receive. Data analysis will follow the principles of randomized controlled trials, and appropriate statistical methods will be used to compare changes in outcomes between groups, controlling for baseline values.

The findings of this study are expected to contribute to the evidence base on digital, nurse-led DSMES interventions for young adults with T2DM. If effective, the program may inform future integration of structured digital education and support into routine diabetes care and may help improve clinical and psychosocial outcomes in this vulnerable age group.

Inclusion criteria

• Age between 18 and 45 years.
• Diagnosis of Type 2 Diabetes Mellitus.
• Able to read and write in the study language.
• Has access to the internet and to a digital device (such as a smartphone, tablet, or computer).
• No communication barriers (e.g., hearing, speech, or severe cognitive impairment that would prevent understanding of the intervention and questionnaires).
• No physical or mental health condition that, in the opinion of the investigators, would prevent participation in the digital intervention and follow-up.
• Willing and able to use a digital platform/application for diabetes self-management education and support.
• Provides informed consent to participate in the study.

Exclusion criteria

• Diagnosis of Type 1 Diabetes Mellitus or gestational diabetes.
• Advanced diabetic retinopathy or other severe visual impairment that significantly limits the ability to use digital devices or read educational materials.
• Severe psychiatric disorder or cognitive impairment that would interfere with participation in the intervention or completion of study assessments.
• Any condition that the investigators judge to make the person unsuitable for participation (e.g., severe acute illness, terminal condition).
• Unwillingness or inability to use the digital platform or to share necessary clinical data for the purposes of the study.