The Role of Nursing, Laboratory Monitoring, and Physiotherapy in Managing Diabetes Type-I-Related Complications
Abstract
Background: Type 1 diabetes mellitus (T1D) is an autoimmune disorder marked by β-cell destruction and absolute insulin deficiency. Morbidity arises from acute events (hypoglycemia, DKA) and chronic micro-/macrovascular complications. Optimal outcomes require interprofessional care integrating nursing, clinical pathology, and physiotherapy alongside insulin therapy and diabetes technologies.
Aim: To synthesize contemporary evidence and practice recommendations on how nursing, laboratory monitoring, and physiotherapy jointly mitigate T1D complications across the disease continuum.
Methods: Narrative critical review of clinical domains outlined in the article—epidemiology, pathophysiology, evaluation, treatment/technology, hypoglycemia prevention, and team-based models—mapped to discipline-specific roles (nursing, clinical pathology, physiotherapy). Core processes (screening, CGM integration, education, exercise prescription) were aligned with outcome targets (HbA1c, time-in-range, complication surveillance).
Results: Nursing-led education, triage, and adherence support reduced acute decompensation, improved device uptake, and strengthened self-management. Clinical pathologists ensured diagnostic accuracy (autoantibodies, OGTT/HbA1c standardization, C-peptide), longitudinal risk stratification, and complication screening (lipid profile, UACR, thyroid/celiac panels). Physiotherapy optimized insulin sensitivity, functional capacity, and fall risk through individualized exercise and neuropathy-aware gait/foot-care programs.
Conclusion: Complication reduction in T1D depends on coordinated insulin replacement, continuous glucose data, structured education, and targeted rehabilitation—operationalized by nurses, pathologists, and physiotherapists within a shared-care framework.
Full text article
References
Holt RIG, DeVries JH, Hess-Fischl A, Hirsch IB, Kirkman MS, Klupa T, Ludwig B, Nørgaard K, Pettus J, Renard E, Skyler JS, Snoek FJ, Weinstock RS, Peters AL. The Management of Type 1 Diabetes in Adults. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2021 Nov;44(11):2589-2625.
Ehrmann D, Kulzer B, Roos T, Haak T, Al-Khatib M, Hermanns N. Risk factors and prevention strategies for diabetic ketoacidosis in people with established type 1 diabetes. Lancet Diabetes Endocrinol. 2020 May;8(5):436-446.
Ramos EL, Dayan CM, Chatenoud L, Sumnik Z, Simmons KM, Szypowska A, Gitelman SE, Knecht LA, Niemoeller E, Tian W, Herold KC., PROTECT Study Investigators. Teplizumab and β-Cell Function in Newly Diagnosed Type 1 Diabetes. N Engl J Med. 2023 Dec 07;389(23):2151-2161.
Škrha J. [ADA Standards of Medical Care in Diabetes 2022 - whats new?]. Vnitr Lek. 2022 Summer;68(2):85-88.
Atkinson MA, Maclaren NK. The pathogenesis of insulin-dependent diabetes mellitus. N Engl J Med. 1994 Nov 24;331(21):1428-36.
Noble JA, Valdes AM. Genetics of the HLA region in the prediction of type 1 diabetes. Curr Diab Rep. 2011 Dec;11(6):533-42.
Leslie RD, Evans-Molina C, Freund-Brown J, Buzzetti R, Dabelea D, Gillespie KM, Goland R, Jones AG, Kacher M, Phillips LS, Rolandsson O, Wardian JL, Dunne JL. Adult-Onset Type 1 Diabetes: Current Understanding and Challenges. Diabetes Care. 2021 Nov;44(11):2449-2456.
Kim SS, Hudgins AD, Yang J, Zhu Y, Tu Z, Rosenfeld MG, DiLorenzo TP, Suh Y. A comprehensive integrated post-GWAS analysis of Type 1 diabetes reveals enhancer-based immune dysregulation. PLoS One. 2021;16(9):e0257265.
Krischer JP, Liu X, Lernmark Å, Hagopian WA, Rewers MJ, She JX, Toppari J, Ziegler AG, Akolkar B., TEDDY Study Group. Predictors of the Initiation of Islet Autoimmunity and Progression to Multiple Autoantibodies and Clinical Diabetes: The TEDDY Study. Diabetes Care. 2022 Oct 01;45(10):2271-2281.
Zorena K, Michalska M, Kurpas M, Jaskulak M, Murawska A, Rostami S. Environmental Factors and the Risk of Developing Type 1 Diabetes-Old Disease and New Data. Biology (Basel). 2022 Apr 16;11(4)
Rahmati M, Keshvari M, Mirnasuri S, Yon DK, Lee SW, Il Shin J, Smith L. The global impact of COVID-19 pandemic on the incidence of pediatric new-onset type 1 diabetes and ketoacidosis: A systematic review and meta-analysis. J Med Virol. 2022 Nov;94(11):5112-5127.
Krischer JP, Liu X, Lernmark Å, Hagopian WA, Rewers MJ, She JX, Toppari J, Ziegler AG, Akolkar B., TEDDY Study Group. Characteristics of children diagnosed with type 1 diabetes before vs after 6 years of age in the TEDDY cohort study. Diabetologia. 2021 Oct;64(10):2247-2257.
Holt RIG, DeVries JH, Hess-Fischl A, Hirsch IB, Kirkman MS, Klupa T, Ludwig B, Nørgaard K, Pettus J, Renard E, Skyler JS, Snoek FJ, Weinstock RS, Peters AL. Correction to: The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2022 Jan;65(1):255
Atkinson MA, Eisenbarth GS, Michels AW. Type 1 diabetes. Lancet. 2014 Jan 04;383(9911):69-82.
Mobasseri M, Shirmohammadi M, Amiri T, Vahed N, Hosseini Fard H, Ghojazadeh M. Prevalence and incidence of type 1 diabetes in the world: a systematic review and meta-analysis. Health Promot Perspect. 2020;10(2):98-115.
Dabelea D, Rewers A, Stafford JM, Standiford DA, Lawrence JM, Saydah S, Imperatore G, D'Agostino RB, Mayer-Davis EJ, Pihoker C., SEARCH for Diabetes in Youth Study Group. Trends in the prevalence of ketoacidosis at diabetes diagnosis: the SEARCH for diabetes in youth study. Pediatrics. 2014 Apr;133(4):e938-45.
ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association 2. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes-2023. Diabetes Care. 2023 Jan 01;46(Suppl 1):S19-S40.
Silver B, Ramaiya K, Andrew SB, Fredrick O, Bajaj S, Kalra S, Charlotte BM, Claudine K, Makhoba A. EADSG Guidelines: Insulin Therapy in Diabetes. Diabetes Ther. 2018 Apr;9(2):449-492.
Hirsch IB, Juneja R, Beals JM, Antalis CJ, Wright EE. The Evolution of Insulin and How it Informs Therapy and Treatment Choices. Endocr Rev. 2020 Oct 01;41(5):733-55.
Ruiz PLD, Chen L, Morton JI, Salim A, Carstensen B, Gregg EW, Pavkov ME, Mata-Cases M, Mauricio D, Nichols GA, Pildava S, Read SH, Wild SH, Shaw JE, Magliano DJ. Mortality trends in type 1 diabetes: a multicountry analysis of six population-based cohorts. Diabetologia. 2022 Jun;65(6):964-972.
Lucier J, Mathias PM. Type 1 diabetes. InStatPearls [Internet] 2024 Oct 5. StatPearls Publishing.
Lucier J, Mathias PM, Doerr C. Type 1 diabetes (nursing). InStatPearls [Internet] 2024 Oct 5. StatPearls Publishing.
Authors
Copyright (c) 2024 Hisham Yahya Alghamdi, Yasamiyan Luayban Ramadan Alanazi, Ali Ahmad Ali Bin Hudayb, Daleela Mahna Al Mutairi, Mona Aaid Alanzi, Fatima Abdo Hadi Shaabi, Huda Abdulhakeem Almarghalani, Hazah Mouhmmad Alrifae Albayre, Abeer Atallah Alenazi, Eshraq Awad Aljohany, Reem Mutlaq Alanzi, Zahi Foriaan Alanzi

This work is licensed under a Creative Commons Attribution 4.0 International License.