Practical guidelines for nursing and midwifery diabetes care – 2026. A position of the Polish Federation for Education in Diabetology

Authors

  • Alicja Szewczyk Department of Endocrinology and Diabetology; Diabetes Clinic, Children’s Memorial Health Institute in Warsaw, Poland Author https://orcid.org/0000-0003-4167-0361
  • Natasza Tobiasz-Kałkun Institute of Health, Faculty of Applied Studies, University of Lower Silesia DSW in Wrocław, Poland Author https://orcid.org/0000-0002-1184-1871
  • Anna Stefanowicz-Bielska 1. Laboratory of Pediatric Nursing, Division of Internal and Pediatric Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdansk; 2. Department of Paediatrics Diabetology, Department of Pediatrics, Diabetology and Endocrinology, University Clinical Center in Gdansk, Poland Author https://orcid.org/0000-0002-1896-5551
  • Ewa Kobos Department of Development of Nursing, Social and Medical Sciences, Faculty of Health Sciences, Medical University of Warsaw, Poland Author https://orcid.org/0000-0001-7231-8411
  • Justyna Kapuściok The Complex of Post-Secondary Medical and Social Schools in Bytom; Individual Nursing Practice, Poland Author https://orcid.org/0009-0003-1294-0489
  • Agnieszka Karczewska 1. University Clinical Hospital No. 1 in Lublin, Poland; 2. Faculty of Medicine, John Paul II Catholic University of Lublin, Poland Author
  • Kamila Mazuryk 1. Department of Hypertension and Diabetology, University Clinical Center in Gdańsk; 2. Department of Surgical Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Poland Author https://orcid.org/0009-0002-3947-7722
  • Beata Hornik Katedra i Zakład Pielęgniarstwa Internistycznego, Wydział Nauk o Zdrowiu, Śląski Uniwersytet Medyczny w Katowicach, Polska Author https://orcid.org/0000-0002-0106-9216

DOI:

https://doi.org/10.12923/pielxxiw-2025-0034

Keywords:

procedures, recommendations, nurse, midwife, diabetes

Abstract

Aim. Presenting a set of procedures describing nursing interventions in diabetes care, including currently available scientific evidence and clinical experience of specialists involved in the care of diabetic patients.

Material and methods. The study involved a literature review of selected areas of nursing practice in diabetes care. When compiling the material, the priority was to use data from: randomized controlled clinical trials and their meta-analyses, systematic reviews, observational studies and other studies with lower levels of evidence.

Results. Based on an analysis of the collected material, 14 procedures and 4 guidelines have been developed, describing selected aspects of nursing interventions in diabetic patients. Each of the procedures details key recommendations on diabetes care, arranged in accordance of the significance ascribed to the scientific evidence analyzed.

Conclusions. The 2026 PFED guidelines on nursing diabetes care are the effect of the evaluation of the previous versions and comprise an updated, considerably more extensive, comprehensive and evidence-based set of practices. The major asset of these guidelines is their interdisciplinarity, reflected in the fact that the final version of the publication was approved by consultants in nursing fields, a consultant in diabetology, and representatives of the medical community from the Polish Diabetes Society. The authors experience gained during work on international recommendations (New Insulin Delivery Recommendations) played an important role when formulating the present guidelines.

References

INTRODUCTION

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16. Hall RM, Dyhrberg S, McTavish A, et al. Where can you wear your Libre? Using the FreeStyle Libre continuous glucose monitor on alternative sites. Diabetes Obes. Metab. 2022;24(4):675-683. https://doi.org/10.1111/dom.14630

17. Messer LH, Berget C, Beatson C, et al. Preserving skin integrity with chronic device use in diabetes. Diabetes Technol. Ther. 2018;20(S2):S254-S264. https://doi.org/10.1089/dia.2018.0080

18. Faccioli S, Del Favero S, Visentin R, et al. PedArPan Study Group. Accuracy of a CGM sensor in pediatric subjects with type 1 diabetes. Comparison of three insertion sites: arm, abdomen, and gluteus. J. Diabetes Sci. Technol. 2017;11(6):1147-1154. https://doi.org/10.1177/1932296817706377

19. Wu PT, Segovia DE, Lee CC, et al. Consistency of continuous ambulatory interstitial glucose monitoring sensors. Biosensors (Basel). 2018;8(2):49. https://doi.org/10.3390/bios8020049

20. Steineck IIK, Mahmoudi Z, Ranjan A, et al. Comparison of continuous glucose monitoring accuracy between abdominal and upper arm insertion sites. Diabetes Technol. Ther. 2019;21(5):295-302. https://doi.org/10.1089/dia.2019.0014

21. Fokkert MJ, van Dijk PR, Edens MA, et al. Performance of the FreeStyle Libre flash glucose monitoring system in patients with type 1 and 2 diabetes mellitus. BMJ Open Diabetes Res. Care. 2017;5(1):e000320. https://doi.org/10.1136/bmjdrc-2016-000320

22. Charleer S, Mathieu C, Nobels F, et al. Accuracy and precision of flash glucose monitoring sensors inserted into the abdomen and upper thigh compared with the upper arm. Diabetes Obes. Metab. 2018;20(6):1503-1507. https://doi.org/10.1111/dom.13239

23. Christensen MO, Berg AK, Rytter K, et al. Skin problems due to treatment with technology are associated with increased disease burden among adults with type 1 diabetes. Diabetes Technol. Ther. 2019;21(4):215-221. https://doi.org/10.1089/dia.2019.0007

24. Eversence 2025. Accessed: 2025-06-11. https://global.eversensediabetes.com/patient-education/eversense-user-guides/

25. Kamann S, Aerts O, Heinemann L. Further evidence of severe allergic contact dermatitis from isobornyl acrylate while using a continuous glucose monitoring system. J. Diabetes Sci. Technol. 2018;12:630-633. https://doi.org/10.1177/1932296818762946

26. Seget S, Rusak E, Partyka M, et al. Bacterial strains colonizing the sensor electrodes of a continuous glucose monitoring system in children with diabetes. Acta Diabetol. 2021;58(2):191-195. https://doi.org/10.1007/s00592-020-01601-w

27. Berg AK, Olsen BS, Thyssen JP, et al. High frequencies of dermatological complications in children using insulin pumps or sensors. Pediatr. Diabetes. 2018;19:733-740. https://doi.org/10.1111/pedi.12652

28. Kamann S, Oppel E, Liu F, et al. Evaluation of isobornyl acrylate content in medical devices for diabetes treatment. Diabetes Technol. Ther. 2019;21(10):533-537. https://doi.org/10.1089/dia.2019.0163

29. McNichol L, Lund C, Rosen T, et al. Medical adhesives and patient safety: state of the science: consensus statements for the assessment, prevention, and treatment of adhesive-related skin injuries. J. Wound Ostomy Continence Nurs. 2013;40:365-380. https://doi.org/10.1097/WON.0b013e3182995516

30. Freckmann G, Buck S, Waldenmaier D, et al. Skin reaction report form: development and design of a standardized report form for skin reactions due to medical devices for diabetes management. J. Diabetes Sci. Technol. 2021;15(4):801-806. https://doi.org/10.1177/1932296820911105

31. Rigo RS, Levin LE, Belsito DV, et al. Cutaneous reactions to continuous glucose monitoring and continuous subcutaneous insulin infusion devices in type 1 diabetes mellitus. J. Diabetes Sci. Technol. 2021;15:786-791. https://doi.org/10.1177/1932296820918894

32. Bolinder J, Antuna R, Geelhoed-Duijvestijn P, et al. Cutaneous adverse events related to FreeStyle Libre device – authors’ reply. Lancet. 2017;389:1396-1397. https://doi.org/10.1016/S0140-6736(17)30893-0

33. Castellana M, Parisi C, Di Molfetta S, et al. Efficacy and safety of flash glucose monitoring in patients with type 1 and type 2 diabetes: a systematic review and meta-analysis. BMJ Open Diabetes Res. Care. 2020;8(1):e001092. https://doi.org/10.1136/bmjdrc-2019-001092

34. Bolinder J, Antuna R, Geelhoed-Duijvestijn P, et al. Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non-masked, randomised controlled trial. Lancet. 2016;388(10057):2254-2263. https://doi.org/10.1016/S0140-6736(16)31535-5

35. Asarani NAM, Reynolds AN, Boucher SE, et al. Cutaneous complications with continuous or flash glucose monitoring use: systematic review of trials and observational studies. J. Diabetes Sci. Technol. 2020;14(2):328-337. https://doi.org/10.1177/1932296819870849

36. O’Neal DN, Adhya S, Jenkins A, et al. Feasibility of adjacent insulin infusion and continuous glucose monitoring via the Medtronic Combo-Set. J. Diabetes Sci. Technol. 2013;7(2):381-388. https://doi.org/10.1177/193229681300700214

37. Ward WK, Castle JR, Jacobs PG, et al. Can glucose be monitored accurately at the site of subcutaneous insulin delivery? J. Diabetes Sci. Technol. 2014;8(3):568-574. https://doi.org/10.1177/1932296814522805

38. Hyry HSI, Liippo JP, Virtanen HM. Allergic contact dermatitis caused by glucose sensors in type 1 diabetes patients. Contact Dermatitis. 2019;81(3):161-166. https://doi.org/10.1111/cod.13337

39. Lombardo F, Passanisi S, Caminiti L, et al. High prevalence of skin reactions among pediatric patients with type 1 diabetes using new technologies: the alarming role of colophonium. Diabetes Technol. Ther. 2020;22(1):53-56. https://doi.org/10.1089/dia.2019.0236

40. Aerts O, Herman A, Bruze M, et al. FreeStyle Libre: contact irritation versus contact allergy. Lancet. 2017;390:1644. https://doi.org/10.1016/S0140-6736(17)32142-6

41. Velasco-Amador JP, Prados-Carmona Á, Navarro-Triviño FJ. [Translated article] Medical devices in patients with diabetes and contact dermatitis. Actas Dermosifiliogr. 2024;115(3):T280-T287. https://doi.org/10.1016/j.ad.2024.01.016

42. Herman A, Darrigade AS, de Montjoye L, et al. Contact dermatitis caused by glucose sensors in diabetic children. Contact Dermatitis. 2020;28(2):105-111. https://doi.org/10.1111/cod.13429

43. Kropff J, Choudhary P, Neupane S, et al. Accuracy and longevity of an implantable continuous glucose sensor in the PRECISE study: a 180-day, prospective, multicenter. pivotal trial. Diabetes Care. 2017;40(1):63-68. https://doi.org/10.2337/dc16-1525

44. Xiong M, Neeley AB. Adverse cutaneous reaction to the Eversense E3 continuous glucose monitor in a platinum-allergic patient. Contact Dermatitis. 2022;87(6):535-536. https://doi.org/10.1111/cod.14200

45. Berg AK, Olsen BS, Thyssen JP, et al. High frequencies of dermatological complications in children using insulin pumps or sensors. Pediatr. Diabetes. 2018;19: 733-740. https://doi.org/10.1111/pedi.12652

46. von Kobyletzki LB, Ulriksdotter J, Sukakul T, et al. Prevalence of dermatitis including allergic contact dermatitis from medical devices used by children and adults with type 1 diabetes mellitus: a systematic review and questionnaire study. J. Eur. Acad. Dermatol. Venereol. 2024;38(7):1329-1346. https://doi.org/10.1111/jdv.19908

47. Bryant RA. Saving the skin from tape injuries. Am. J. Nurs.1988; 88:189-191.

48. Medtronic Diabetes: tape tips and site management. Accessed: 2025-06-13. https://www.medtronicdiabetes.com/sites/default/files/library/download-library/workbooks/Tape%20Tips%20and%20Site%20Management.pdf

49. Englert K, Ruedy K, Coffey J, et al. Skin and adhesive issues with continuous glucose monitors: a sticky situation. J. Diabetes Sci. Technol. 2014;8:745-751. https://doi.org/10.1177/1932296814529893

50. Ives B, Sikes K, Urban A, et al. Practical aspects of realtime continuous glucose monitors: the experience of the Yale Children’s Diabetes Program. Diabetes Educ. 2010;36:53-62. https://doi.org/10.1177/0145721709352010

51. Bailey T, Bode BW, Christiansen MP, et al. The performance and usability of a factory-calibrated flash glucose monitoring system. Diabetes Technol. Ther. 2015;17(1):787-794. https://doi.org/10.1089/dia.2014.0378

52. Freckmann G, Pleus S, Grady M, et al. Measures of accuracy for continuous glucose monitoring and blood glucose monitoring devices. J. Diabetes Sci. Technol. 2019;13(3):575-583. https://doi.org/10.1177/1932296818812062

53. Basu A, Dube S, Veettil S, et al. Time lag of glucose from intravascular to interstitial compartment in type 1 diabetes. J. Diabetes Sci. Technol. 2015;9(1):63-68. https://doi.org/10.1177/1932296814554797

54. Scuffi C. Interstitium versus blood equilibrium in glucose concentration and its impact on subcutaneous continuous glucose monitoring systems. Eur. J. Endocrinol. 2014;10(1):36-42. https://doi.org/10.17925/EE.2014.10.01.36

55. Müller-Korbsch M, Rega-Kaun G, Fasching P, et al. RtCGM performance at different sensor wear sites during prolonged aerobic exercise – can the rtCGM sensor be worn anywhere on the body? J. Diabetes Sci. Technol. 2022;16(1):250-251. https://doi.org/10.1177/19322968211036756

56. Bellido V, Freckman G, Pérez A, et al. Accuracy and potential interferences of continuous glucose monitoring sensors in the hospital. Endocr. Prac. 2023;29(11):919-927. https://doi.org/10.1016/j.eprac.2023.06.007

57. Araszkiewicz A, Borys S, Broncel M, et al. Standards of care in diabetes. The position of Diabetes Poland – 2025. Curr. Top. Diabet. 2025;5(1):1-157. https://doi.org/10.5114/ctd/203685

58. American Diabetes Association Professional Practice Committee; 7. Diabetes technology: Standards of care in diabetes – 2025. Diabetes Care. 2025; 48(1):S146-S166. https://doi.org/10.2337/dc25-S007

59. Patil SP, Albanese-O’Neill A, Yehl K, et al. Professional competencies for diabetes technology use in the care setting. Sci. Diabetes Self Manag. Care. 2022;48:437-445. https://doi.org/10.1177/26350106221120889

60. Matievich W, Kiaie N, Dunn TC. Safety and functional integrity of continuous glucose monitoring sensors when used during radiologic procedures under high exposure conditions. J. Diabetes Sci. Technol. 2023;17(6):1634-1643. https://doi.org/10.1177/19322968221106206

61. Pemberton JS, Kershaw M, Dias R, et al. DYNAMIC: Dynamic glucose management strategies delivered through a structured education program improves time in range in a socioeconomically deprived cohort of children and young people with type 1 diabetes with a history of hypoglycemia. Pediatr. Diabetes. 2021;22(2):249-260. https://doi.org/10.1111/pedi.13155

62. Schlüter S, Freckmann G, Heinemann L, et al. Evaluation of the SPECTRUM training programme for real-time continuous glucose monitoring: a real-world multicentre prospective study in 120 adults with type 1 diabetes. Diabet. Med. 2021;38(2):e14467. https://doi.org/10.1111/dme.14467

63. Kim JY, Jin SM, Sim KH, et al. Continuous glucose monitoring with structured education in adults with type 2 diabetes managed by multiple daily insulin injections: a multicentre randomised controlled trial. Diabetologia. 2024;67(7):1223-1234. https://doi.org/10.1007/s00125-024-06152-1

64. Romero-Castillo R, Pabón-Carrasco M, Jiménez-Picón N, et al. Effects of a diabetes self-management education program on glucose levels and self-care in type 1 diabetes: a pilot randomized controlled trial. Int. J. Environ. Res. Public Health. 2022;19(23):16364. https://doi.org/10.3390/ijerph192316364

65. Borot S, Benhamou PY, Atlan C, et al. Practical implementation, education and interpretation guidelines for continuous glucose monitoring: a French position statement. Diabetes Metab. 2018;44(1):61-72. https://doi.org/10.1016/j.diabet.2017.10.009

66. Hermanns N, Ehrmann D, Schipfer M, et al. The impact of a structured education and treatment programme (FLASH) for people with diabetes using a flash sensor-based glucose monitoring system: results of a randomized controlled trial. Diabetes Res. Clin. Pract. 2019;150:111-121. https://doi.org/10.1016/j.diabres.2019.03.003

67. Pintus D, Ng SM. FreeStyle Libre flash glucose monitoring improves patient quality of life measures in children with type 1 diabetes mellitus (T1DM) with appropriate provision of education and support by healthcare professionals. Diabetes Metab. Syndr. 2019;13(5):2923-2926. https://doi.org/10.1016/j.dsx.2019.07.054

68. Mauri A, Schmidt S, Sosero V, et al. A structured therapeutic education program for children and adolescents with type 1 diabetes: an analysis of the efficacy of the „Pediatric Education for Diabetes” project. Minerva Pediatr. (Torino). 2021;73(2):159-166. https://doi.org/10.23736/S2724-5276.17.04634-5

69. Yuksel M, Bektas H, Ozer ZC. The effect of nurse-led diabetes self-management programmes on glycosylated haemoglobin levels in individuals with type 2 diabetes: a systematic review. Int. J. Nurs. Pract. 2023;(6):e13175. https://doi.org/10.1111/ijn.13175

70. Yoo JH, Kim G, Lee HJ, et al. Effect of structured individualized education on continuous glucose monitoring use in poorly controlled patients with type 1 diabetes: a randomized controlled trial. Diabetes Res. Clin. Pract. 2022;184:109209. https://doi.org/10.1016/j.diabres.2022.109209

III. SUBCUTANEOUS INSULIN INJECTION USING A PEN INJECTOR

1. Gorska-Ciebiada M, Masierek M, Ciebiada M. Improved insulin injection technique, treatment satisfaction and glycemic control: results from a large cohort education study. J. Clin. Transl. Endocrinol. 2020;19:100217. https://doi.org/10.1016/j.jcte.2020.100217

2. Heise T, Nosek L, Dellweg S, et al. Impact of injection speed and volume on perceived pain during subcutaneous injections into the abdomen and thigh: a single-centre, randomized controlled trial. Diabetes Obes. Metab. 2014;16(10):971-976. https://doi.org/10.1111/dom.12304

3. Leonardi L, Vigano M, Nicolucci A. Penetration force and cannula sliding profiles of different pen needles: the PICASSO study. Med. Devices. 2019;12:311-317. https://doi.org/10.2147/MDER.S218983

4. McKay M, Compion G, Lytzen LA, et al. Comparison of insulin injection needles on patients’ perceptions of pain, handling, and acceptability: a randomized, open-label, crossover study in subjects with diabetes. Diabetes Technol. Ther. 2009;11(3):195-201. https://doi.org/10.1089/dia.2008.0054

5. Frid AH, Kreugel G, Grassi G. et al. New insulin delivery recommendations. Mayo Clin. Proc. 2016;91(9):1231-1255. https://doi.org/10.1016/j.mayocp.2016.06.010

6. Lim STJ, Hui YCA, Lim PK, et al. Ultrasound-guided measurement of skin and subcutaneous tissue thickness in children with diabetes and recommendations for giving insulin injections. J. Clin. Transl. Endocrinol. 2018;12:26-35. https://doi.org/10.1016/j.jcte.2018.04.004

7. Lo Presti D, Ingegnosi C, Strauss K. Skin and subcutaneous thickness at injecting sites in children with diabetes: ultrasound findings and recommendations for giving the injection. Pediatr. Diabetes. 2012;13(7):525-533. https://doi.org/10.1111/j.1399-5448.2012.00865.x

8. Gentile S, Guarino G, Della Corte T, et al. The durability of an intensive, structured education-based rehabilitation protocol for best insulin injection practice: The ISTERP-2 study. Study Group on Injection Technique; Nefrocenter Research and Nyx Start-Up Study Group. Diabetes Ther. 2021;12(9):2557-2569. https://doi.org/10.1007/s13300-021-01108-9

9. Hirsch LJ, Strauss KW. The injection technique factor: What you don’t know or teach can make a difference. Clin. Diabetes. 2019;37(3):227-233. https://doi.org/10.2337/cd18-0076

10. Misnikova IV, Gubkina VA, Lakeeva TS, at al. A randomized controlled trial to assess the impact of proper insulin injection technique training on glycemic control. Diabetes Ther. 2017;8(6):1309-1318. https://doi.org/10.1007/s13300-017-0315-y

11. Pettis RJ, Muchmore D, Heinemann LJ. Subcutaneous insulin administration: sufficient progress or ongoing need? J. Diabetes Sci. Technol. 2019;13(1):3-7. https://doi.org/10.1177/1932296818817011

12. La Rosa C, Makkar H, Grant-Kels JM. Approach to the total body skin examination in adults and children: kids are not just little people. Clin. Dermatol. 2017;35(6):500-503. https://doi.org/10.1016/j.clindermatol.2017.08.001

13. Rini C, Roberts BC, Morel D, et al. Evaluating the impact of human factors and pen needle design on insulin pen injection. J. Diabetes Sci. Technol. 2019;13(3):533-545. https://doi.org/10.1177/1932296819836987

14. McKay M, Compion G, Lytzen LA, et al. Comparison of insulin injection needles on patients’ perceptions of pain, handling, and acceptability: a randomized, open-label, crossover study in subjects with diabetes. Diabetes Technol. Ther. 2009;11(3):195-201. https://doi.org/10.1089/dia.2008.0054

15. Regulation of the Minister of Health of February 28, 2017 on the kind and scope of preventive, diagnostic, treatment, and rehabilitation services provided by a nurse or midwife independently, without a medical order (Journal of Laws 2017, item 497).

16. Misnikova IV, Dreval AV, Gubkina VA, et al. The risks of repeated use of insulin pen needles in patients with diabetes mellitus. J. Diabetol. 2011;2(1):2.

17. Soltani H, Fraser R. A longitudinal study of maternal anthropometric changes in normal weight, overweight and obese women during pregnancy and postpartum. Br. J. Nutr. 2000;84(1):95-101. https://doi.org/10.1017/s0007114500001276

18. Regulation of the Minister of Infrastructure of 12 April, 2002 on technical conditions which must be fulfilled by buildings and their location. Journal of Laws. 2002;75:690.

19. WHO Expert Committee on Specifications for Pharmaceutical Preparations. Model guidance for the storage and transport of time- and temperature–sensitive pharmaceutical products. World Health Organ Tech Rep. Ser. 2011;961(9):321-378.

20. Vimalavathini R, Gitanjali B. Effect of temperature on the potency & pharmacological action of insulin. Indian J. Med. Res. 2009;130(2):166-169.

21. Heinemann L, Nguyen T, Bailey ST. Needle technology for insulin administration: a century of innovation. J. Diabetes Sci. Technol. 2021:2(17)1-9. https://doi.org/10.1177/19322968211059564

22. Fleming D, Jacober SJ, Vanderberg M, et al. The safety of injecting insulin through clothing. Diabetes Care. 1997;20:244-247. https://doi.org/10.2337/diacare.20.3.244

23. Gorman KC. Good hygiene versus alcohol swabs before insulin injections (Letter). Diabetes Care. 1993;16:960-961. https://doi.org/10.2337/diacare.16.6.960

24. Olmo DZ, Vlacho B, Fernández J, et al. Safety of the reuse of needles for subcutaneous insulin injection: a systematic review and meta-analysis. Int. J. Nurs. Stud. 2016;60:121-132. https://doi.org/10.1016/j.ijnurstu.2016.04.010

25. International Organization for Standardization. Needle-based injection systems for medical use – requirements and test methods (ISO11608-1:2022). https://www.iso.org/standard/70733.html. Published 2022. Accessed: 2025-06-11.

26. Notice of the Minister of Health of December 20, 2021 on the list of reimbursed drugs, foodstuffs intended for particular nutritional use and medical devices as of January 1, 2022. Journal of Laws. 2021; 82.

27. Hanas R. I-Port indwelling catheter alleviates injection pain in children with diabetes. Pediatr. Diabetes. 2013;14(18):114.

28. Simpson V, Jones A. Switching to reusable cartridge insulin pens can reduce National Health Service costs while delivering environmental benefits. Diabet. Med. 2024;41:e15409. https://doi.org/10.1111/dme.15409

29. Jendle J, Ericsson Å, Gundgaard J, et al. Smart insulin pens are associated with improved clinical outcomes at lower cost versus standard-of-care treatment of type 1 diabetes in Sweden: a cost-effectiveness analysis. Diabetes Ther. 2021;12(1):373-388. https://doi.org/10.1007/s13300-020-00980-1

30. Nguyen KT, Zhang JY, Heinemann L, et al. The diabetes technology society green declaration. J. Diabetes Sci. Technol. 2022;16:215-217. https://doi.org/10.1177/19322968211051721

IV. SUBCUTANEOUS INJECTION OF GLP-1 RECEPTOR AGONISTS AND A DUAL GLP-1/GIP RECEPTOR AGONIST USING AN INJECTOR AN INJECTOR

1. Huthmacher JA, Meier JJ, Nauck MA. Efficacy and safety of short- and long-acting glucagon-like peptide 1 receptor agonists on a background of basal insulin in type 2 diabetes: a meta-analysis. Diabetes Care. 2020; 43:2303-2312. https://doi.org/10.2337/dc20-0498

2. Wang L. Designing a dual GLP-1R/GIPR agonist from Tirzepatide: comparing residues between Tirzepatide, GLP-1, and GIP. Drug Des. Devel. Ther. 2022;16:1547-1559. https://doi.org/10.2147/DDDT.S358989

3. Dąbrowska L. Modern antidiabetic medications – a review excluding insulins, sulfonylureas, biguanides, and α-glucosidase derivatives. Review paper developed in the course of specialist training in Retail Pharmacy. Zielona Góra; 2019, p. 1-13.

4. Frias JP, Bonora E, Nevarez Ruiz LA, et al. Efficacy and safety of Dulaglutide 3 mg and 4.5 mg vs. Dulaglutide 1.5 mg: 52-week results from AWARD- 11. Diabetes Care. 2020;69(Suppl. 1):357. https://doi.org/10.2337/dc20-1473

5. le Roux CW, Astrup A, Fujioka K, et al. 3 years of Liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double-blind trial. Lancet. 2017;389:1399-1409. https://doi.org/10.1016/S0140-6736(17)30069-7

6. Rosenstock J, Wysham C, Frías JP, et al. Efficacy and safety of a novel dual GIP and GLP-1 receptor agonist Tirzepatide in patients with type 2 diabetes (SURPASS-1): a double-blind, randomised, phase 3 trial. Lancet. 2021;398(10295):143-155. https://doi.org/10.1016/S0140-6736(21)01324-6

7. American Diabetes Association Professional Practice Committee; 9. Pharmacologic approaches to glycemic treatment: standards of care in diabetes – 2025. Diabetes Care. 2025;48(Suppl.1):S181-S206. https://doi.org/10.2337/dc25-S009

8. Smolarek I, Jabłecka A. Drugs acting on the incretin system in the treatment of type 2 diabetes mellitus. Farm. Współcz. 2016;9:61-66.

9. Wadden TA, Tronieri JS, Sugimoto D, et al. Liraglutide 3.0 mg and intensive behavioral therapy (IBT) for obesity in primary care: the SCALE IBT randomized controlled trial. Obesity (Silver Spring). 2020;28:529-536. https://doi.org/10.1002/oby.22726

10. Nauck MA, Meier JJ. Management of endocrine disease: are all GLP-1 agonists equal in the treatment of type 2 diabetes? Eur. J. Endocrinol. 2019;181(6):211-234. https://doi.org/10.1530/EJE-19-0566

11. Summary of product characteristics. Bydureon. Accessed: 2025-06-25. https://ec.europa.eu/health/documents/community-register/2011/20110617103730/anx_103730_pl.pdf

12. Summary of product characteristics. Byetta. Accessed: 2025-06-25. https://ec.europa.eu/health/documents/community-register/2016/20160722135247/anx_135247_pl.pdf

13. Summary of product characteristics. Trulicity. Accessed: 2025-06-25. https://leki.urpl.gov.pl/files/49_Trulicity.pdf

14. Summary of product characteristics. Victoza. Accessed: 2025-06-25. https://www.ema.europa.eu/en/documents/product-information/victoza-epar-product-information_pl.pdf

15. Roszkiewicz M. New technologies and medications in type 1 and 2 diabetes treatment. Review paper developed in the course of specialist training in Retail Pharmacy. Gdańsk; 2019, p. 1-25.

16. Kostrzewa-Zabłocka E. Pharmaceutical methods. Oral medication treatment. In: Szewczyk A. (ed.) Diabetes nursing. Warsaw: PZWL; 2019.

17. Walden E. Insulin and non-insulin injectable therapy administration policy. Diabetes specialist nurse team. Lincolnshire Community Health Services NHS Trust. 2020;1-57.

18. Jones SC, Ryan DL, Pratt VS, et al. Injection-site nodules associated with the use of exenatide extended-release reported to the US Food and Drug Administration Adverse Event Reporting System. Diabetes Spectr. 2015;28(4):283-288. https://doi.org/10.2337/diaspect.28.4.283

V. USE OF AN INFUSION SET IN CONTINUOUS SUBCUTANEOUS INSULIN INFUSION (CSII) THERAPY USING A PERSONAL INSULIN PUMP

1. Heinemann L, Krinelke I. Insulin infusion set: the Achilles heel of continuous subcutaneous insulin infusion. J. Diabetes Sci. Technol. 2012;6(4):954-964. https://doi.org/10.1177/193229681200600429

2. Frid AH, Kreugel G, Grassi G, et al. New insulin delivery recommendations. Mayo Clin. Proc. 2016;91(9):1231-1255. https://doi.org/10.1016/j.mayocp.2016.06.010

3. Conwell LS, Pope E, Artiles AM, et al. Dermatological complications of continuous subcutaneous insulin infusion in children and adolescents. J. Pediatr. 2008;152(5):622-662. https://doi.org/10.1016/j.jpeds.2007.10.006

4. Overland J, Molyneaux L, Tewari S, et al. Lipohypertrophy: does it matter in daily life? A study using a continuous glucose monitoring system. Diabetes Obes. Metab. 2009;11(5):460-463. https://doi.org/10.1111/j.1463-1326.2008.00972.x

5. Phillip M, Battelino T, Rodriguez H, et al. Use of insulin pump therapy in the pediatric age-group: consensus statement from the European Society for Paediatric Endocrinology, the Lawson Wilkins Pediatric Endocrine Society, and the International Society for Pediatric and Adolescent Diabetes, endorsed by the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2007;30(6):1653-1662. https://doi.org/10.2337/dc07-9922

6. Schmid V, Hohberg C, Borchert M, et al. Pilot study for assessment of optimal frequency for changing catheters in insulin pump therapy-trouble starts on day 3. J. Diabetes Sci. Technol. 2010;4(4):976-982. https://doi.org/10.1177/193229681000400429

7. Thethi TK, Rao A, Kawji H, et al. Consequences of delayed pump infusion line change in patients with type 1 diabetes mellitus treated with continuous subcutaneous insulin infusion. J. Diabetes Complications. 2010;24(2):73-78. https://doi.org/10.1016/j.jdiacomp.2009.03.002

8. Kerr D, Morton J, Whately-Smith C, et al. Laboratory-based non-clinical comparison of occlusion rates using three rapid-acting insulin analogs in continuous subcutaneous insulin infusion catheters using low flow rates. J. Diabetes Sci. Technol. 2008;2(3):450-455. https://doi.org/10.1177/193229680800200314

9. van Faassen I, Razenberg PP, Simoons-Smit AM, et al. Carriage of Staphylococcus aureus and inflamed infusion sites with insulin-pump therapy. Diabetes Care. 1989;12(2):153-155. https://doi.org/10.2337/diacare.12.2.153

10. American Diabetes Association Professional Practice Committee. 7. Diabetes technology: standards of care in diabetes – 2025. Diabetes Care. 2025;48(Suppl.1): S146-S166. https://doi.org/10.2337/dc25-S007

11. Ehrmann D, Kulzer B, Schipfer M, et al. Efficacy of an education program for people with diabetes and insulin pump treatment (INPUT): results from a randomized controlled trial. Diabetes Care. 2018;41(12):2453-2462. https://doi.org/10.2337/dc18-0917

12. Zhang JY, Shang T, Chattaraj S, et al. Advances in insulin pump infusion sets symposium report. J. Diabetes Sci. Technol. 2021;15(3):705-709. https://doi.org/10.1177/1932296821999080

13. Szadkowska A, Chobot A, Głowińska-Olszewska B, et al. Guidelines of the Polish Society of Pediatric Endocrinology and Diabetology and Pediatric Section of Diabetes Poland on insulin therapy using hybrid closed-loop systems in children and adolescents with diabetes in Poland. Pediatr. Endocrinol. Diabetes. Metab. 2024;30(3):132-147. https://doi.org/10.5114/pedm.2024.144041

14. Gallen G, Rosso A, Alonso-Carril N, et al. Expert panel opinion on the optimal educational pathway for diabetes educators for training people with type 1 diabetes on the MiniMed™ 780G system: a Delphi consensus. Acta Diabetol. 2025; 62(5):685-694. https://doi.org/10.1007/s00592-024-02388-w

VI. MANAGEMENT OF HYPOGLYCEMIA IN A DIABETIC PATIENT

1. International Hypoglycemia Study Group. Glucose concentrations of less than 3 mmol/L (54 mg/dL) should be reported in clinical trials: a joint position statement of the American Diabetes Association and European Association for the Study of Diabetes. Diabetes Care. 2017;40(1):155-157. https://doi.org/10.2337/dc16-2215

2. International Hypoglycemia Study Group. Minimizing hypoglycemia in diabetes. Diabetes Care. 2015;38(8):1583-1591. https://doi.org/10.2337/dc15-0279

3. Pratiwi C, Mokoagow MI, Made Kshanti IA, et al. The risk factors of inpatient hypoglycemia: a systematic review. Heliyon. 2020;6(5);1-6. https://doi.org/10.1016/j.heliyon.2020.e03913

4. De Buck E, Borra V, Carlson JN, et al. First aid glucose administration routes for symptomatic hypoglycaemia. Emergencias. 2021;33(2):135-136. https://doi.org/10.1002/14651858.CD013283.pub2

5. American Diabetes Association Professional Practice Committee. 6. Glycemic goals and hypoglycemia: standards of care in diabetes – 2025. Diabetes Care. 2025;48(Suppl.1):S128-S145. https://doi.org/10.2337/dc25-S006

6. Araszkiewicz A, Borys S, Broncel M, et al. Standards of care in diabetes. The position of Diabetes Poland – 2025. Curr. Top. Diabet. 2025;5(1):1-157. https://doi.org/10.5114/ctd/203685

7. Product leaflets and usage instructions: https://www.novonordisk.pl/content/dam/nncorp/pl/pl/pdfs/products/GlucaGen_ulotka_dla_pacjenta.pdf Accessed: 2025-06-19.

8. Package leaflet: https://ec.europa.eu/health/documents/community-register/2019/ 20191216146478/anx_146478_pl.pdf Accessed: 2025-06-15.

9. Seaquist ER, Anderson J, Childs B, et al. Hypoglycemia and diabetes: a report of a work group of the American Diabetes Association and the Endocrine Society. Diabetes Care. 2013;36(5):1384-1395. https://doi.org/10.2337/dc12-2480

10. Gimenez M, Tannen AJ, Reddy M, et al. Revisiting the relationships between measures of glycemic control and hypoglycemia in continuous glucose monitoring data sets. Diabetes Care. 2018;41(2):326-332. https://doi.org/10.2337/dc17-1597

11. Hopkins D, Lawrence I, Mansell P, et al. Improved biomedical and psychological outcomes 1 year after structured education in flexible insulin therapy for people with type 1 diabetes. Diabetes Care. 2012;35(8):1638-1642. https://doi.org/10.2337/dc11-1579

12. Reddy M, Jugnee N, El Laboudi A, et al. A randomized controlled pilot study of continuous glucose monitoring and flash glucose monitoring in people with type 1 diabetes and impaired awareness of hypoglycaemia. Diabet. Med. 2018;35(4):483-490. https://doi.org/10.1111/dme.13561

13. Pratley RE, Kanapka LG, Rickels MR, et al. Effect of continuous glucose monitoring on hypoglycemia in older adults with type 1 diabetes a randomized clinical trial. JAMA. 2020;16;323(23): 2397-2406. https://doi.org/10.1001/jama.2020.6928

14. Hermanns N, Heinemann L, Freckmann G, et al. Impact of CGM on the management of hypoglycemia problems: overview and secondary analysis of the HypoDE study. J. Diabetes Sci. Technol. 2019;13:636-644. https://doi.org/10.1177/1932296819831695

15. Chantal M. Minimising hypoglycaemia in the real world: the challenge of insulin. Diabetologia. 2021;64(5):978-984. https://doi.org/10.1007/s00125-020-05354-7

16. Hermanns N, Kulzer B, Krichbaum M, et al. Long-term effect of an education program (HyPOS) on the incidence of severe hypoglycemia in patients with type 1 diabetes. Diabetes Care. 2010;33(3):e36. https://doi.org/10.2337/dc09-1656

17. Choudhary P, Rickels MR, Senior PA, et al. Evidence-informed clinical practice recommendations for treatment of type 1 diabetes complicated by problematic hypoglycemia. Diabetes Care. 2015;38(6):1016-1029. https://doi.org/10.2337/dc15-0090

18. Little SA, Leelarathna L, Walkinshaw E, et al. Recovery of hypoglycemia awareness in long-standing type 1 diabetes: a multicenter 2 × 2 factorial randomized controlled trial comparing insulin pump with multiple daily injections and continuous with conventional glucose self-monitoring (HypoCOMPaSS). Diabetes Care. 2014;37(8):2114-2122. https://doi.org/10.2337/dc15-0090

19. Deeb LC, Dulude H, Guzman CB, et al. A phase 3 multicenter, open-label, prospective study designed to evaluate the effectiveness and ease of use of nasal glucagon in the treatment of moderate and severe hypoglycemia in children and adolescents with type 1 diabetes in the home or school setting. Pediatr. Diabetes. 2018;19(5):1007-1013. https://doi.org/10.1111/pedi.12668

20. Bloomfield HE, Greer N, Newman D, et al. Predictors and consequences of severe hypoglycemia in adults with diabetes – a systematic review of the evidence. Washington, DC, Department of Veterans Affairs, 2012.

21. Barendse S, Singh H, Frier BM, et al. The impact of hypoglycaemia on quality of life and related patient-reported outcomes in type 2 diabetes: a narrative review. Diabet. Med. 2012;29:293-302. https://doi.org/10.1111/j.1464-5491.2011.03416.x

22. McCoy RG, Van Houten HK, Ziegenfuss JY, et al. Self-report of hypoglycemia and health-related quality of life in patients with type 1 and type 2 diabetes. Endocr. Pract. 2013;19:792-799. https://doi.org/10.4158/EP12382.OR

23. Leiter LA, Boras D, Woo VC. Dosing irregularities and self-treated hypoglycemia in type 2 diabetes: results from the Canadian cohort of an international survey of patients and healthcare professionals. Can. J. Diabetes. 2014;38:38-44. https://doi.org/10.1016/j.jcjd.2013.08.270

24. Powers MA, Bardsley JK, Cypress M, et al. Diabetes self-management education and support in adults with type 2 diabetes: a consensus report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. Diabetes Care. 2020;43:1636-1649. https://doi.org/10.2337/dci20-0023

25. LaManna J, Litchman ML, Dickinson JK, et al. Diabetes education impact on hypoglycemia outcomes: a systematic review of evidence and gaps in the literature. Diabetes Educ. 2019;45:349-369. https://doi.org/10.1177/0145721719855931

VII. REDUCING PERIOPERATIVE COMPLICATION RISK

1. Crowley K, Scanaill PÓ, Hermanides J, et al. Current practice in the perioperative management of patients with diabetes mellitus: a narrative review. Br. J. Anaesth. 2023;131(2):242-252. https://doi.org/10.1016/j.bja.2023.02.039

2. Copanitsanou P, Dafogianni C, Iraklianou S. Perioperative management of adult patients with diabetes mellitus. Int. J. Caring. Sci. 2016;9(3):1167-1176.

3. Galway U, Chahar P, Schmidt MT, et al. Perioperative challenges in management of diabetic patients undergoing non-cardiac surgery. World J. Diabetes. 2021;12(8):1255-1266. https://doi.org/10.4239/wjd.v12.i8.1255

4. Araszkiewicz A, Borys S, Broncel M, et al. Standards of care in diabetes. The position of Diabetes Poland – 2025. Curr. Top. Diabet. 2025;5(1):1-157. https://doi.org/10.5114/ctd/203685

5. Kang ZQ, Huo JL, Zhai XJ. Effects of perioperative tight glycemic control on postoperative outcomes: a meta-analysis. Endocr. Connect. 2018;7(12):R316-R327. https://doi.org/10.1530/EC-18-0231

6. Boreland L, Scott-Hudson M, Hetherington K, et al. The effectiveness of tight glycemic control on decreasing surgical site infections and readmission rates in adult patients with diabetes undergoing cardiac surgery: a systematic review. Heart Lung. 2015;44:430e-440e. https://doi.org/10.1016/j.hrtlng.2015.06.004

7. Hweidi IM, Zytoo AM, Hayajneh AA. Tight glycaemic control and surgical site infections post cardiac surgery: a systematic review. J. Wound Care. 2021;30(Suppl.12):S22-S28. https://doi.org/10.12968/jowc.2021.30.Sup12.S22

8. Kotagal M, Symons RG, Hirsch IB, et al. Perioperative hyperglycemia and risk of adverse events among patients with and without diabetes. Ann. Surg. 2015;261:97-103. https://doi.org/10.1097/SLA.0000000000000688

9. Martin ET, Kaye KS, Knott C, et al. Diabetes and risk of surgical site infection: a systematic review and meta-analysis. Infect. Control. Hosp. Epidemiol. 2016;37:88-99. https://doi.org/10.1017/ice.2015.249

10. Rutan L, Sommers K. Hyperglycemia as a risk factor in the perioperative patient. AORN Journal. 2012;95(3):352-61. https://doi.org/10.1016/j.aorn.2011.06.010

11. Talyancich O. Type 1 diabetes mellitus in the perioperative environment. The Dissector. 2021;49(2):33-37. https://link.gale.com/apps/doc/A698648652/AONE?u= anon~557f441e&sid=googleScholar&xid=c232eb77

12. Ayas NT, Jeklin AT, Tholin H, et al. Consecutive nursing shifts and the risk of hypoglycemia in critically ill patients who are receiving intravenous insulin: a multicenter study. J. Clin. Sleep Med. 2020;16(6):949-953. https://doi.org/10.5664/jcsm.8382

VIII. PREVENTION OF DIABETIC FOOT DISEASE

1. Aalaa M, Tabatabaei Malazy O, Sanjari M, et al. Nurses’ role in diabetic foot prevention and care; a review. J. Diabetes Metab. Disord. 2012;11:24. https://doi.org/10.1186/2251-6581-11-24

2. American Diabetes Association Professional Practice Committee. 12. Retinopathy, neuropathy, and foot care: standards of care in diabetes – 2025. Diabetes Care. 2025;48(Suppl.1):S252-S265. https://doi.org/10.2337/dc25-S012

3. Bus SA, Lavery LA, Monteiro Soares M, et al. Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update). Diabetes Metab. Res. Rev. 2020;36(S1):e3269. https://doi.org/10.1002/dmrr.3269

4. DiGiovanni ChW, Greisberg J. The foot and the talocrural joint. Wrocław: Elsevier Urban & Partner; 2010, p. 18-31.

5. Klamczyńska M, Ciupińska M. Podology. Warsaw: PZWL; 2020, p. 258-279.

6. Levine D, Richard J, Whittle WM. Gait analysis. Wrocław; Elsevier Urban & Partner: 2014, p. 87-90, 115-116, 181.

7. Diabetic foot problems: prevention and management. National Institute for Health and Care Excellence (NICE), 2023. Accessed: 2025-06-15. https://www.ncbi.nlm.nih.gov/books/NBK553608/

8. Rakowska B, Jawień A, Sopata M, et al. The organization of health care of patients with diabetic foot syndrome. Guidelines of Polish Wound Management Association. Wound Treatment. 2015;12(3):83-112. https://doi.org/10.15374/LR20015011

9. Schaper NC, van Netten JJ, Apelqvist J, et al. IWGDF Editorial Board. Practical guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes Metab. Res. Rev. 2020;36(S1):e3266. https://doi.org/10.1002/dmrr.3266

10. Crawford F, Cezard G, Chappell FM, et al. A systematic review and individual patient data meta-analysis of prognostic factors for foot ulceration in people with diabetes: the international research collaboration for the prediction of diabetic foot ulcerations (PODUS). Health Technol Assess. Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update). Health Technol. Assess. 2015;19(57):1-210. https://doi.org/10.3310/hta19570

11. Young M, Townson M, Hicks G. A photographic scale to aid appropriate foot skin care for people with diabetes. Diab. Foot J. 2015;3: 29-32.

12. Van Netten JJ, Price PE, Laverty LA, et al. Prevention of foot ulcers in the at-risk patient with diabetes: a systematic review. Diabetes Metab. Res. Rev. 2016;32(1):84-98. https://doi.org/10.1002/dmrr.2701

IX. CARE SKIN HYGIENE IN INDIVIDUALS WITH DIABETES

1. Campos de Macedo GM, Nunes S, Barreto T. Skin disorders in diabetes mellitus: an epidemiology and physiopathology review. Diabetol. Metab. Syndr. 2016;8:63. https://doi.org/10.1186/s13098-016-0176-y

2. Fan L, Sidani S, Cooper-Brathwaite A, et al. Improving foot self-care knowledge, self-efficacy, and behaviors in patients with type 2 diabetes at low risk for foot ulceration: a pilot study. Clin. Nurs. Res. 2014;23(6):627-643. https://doi.org/10.1177/1054773813491282

3. Federici A, Federici G, Milani M. An urea, arginine and carnosine based cream (Ureadin Rx Db ISDIN) shows greater efficacy in the treatment of severe xerosis of the feet in type 2 diabetic patients in comparison with glycerol-based emollient cream. A randomized, assessor-blinded, controlled trial. BMC Dermatol. 2012;12:16. https://doi.org/10.1186/1471-5945-12-16

4. Martini J, Huertas C, Turlier V, et al. Efficacy of an emollient cream in the treatment of xerosis in diabetic foot: a double-blind, randomized, vehicle-controlled clinical trial. J. Eur. Acad. Dermatol. Venereol. 2017;31(4):743-747. https://doi.org/10.1111/jdv.14095

5. Nguyen TPL, Edwards H, Do TND, et al. Effectiveness of a theory-based foot care education program (3STEPFUN) in improving foot self-care behaviours and foot risk factors for ulceration in people with type 2 diabetes. Diabetes Res. Clin. Pract. 2019;152:29-38. https://doi.org/10.1016/j.diabres.2019.05.003

6. Papanas N, Papazoglou D, Papatheodorou K, et al. Evaluation of a new foam to increase skin hydration of the foot in type 2 diabetes: a pilot study. Int. Wound J. 2011;8:297-300. https://doi.org/10.1111/j.1742-481X.2011.00786.x

7. Pham HT, Exelbert L, Segal-Owens AC, et al. A prospective, randomized, controlled double-blind study of a moisturizer for xerosis of the feet in patients with diabetes. Ostomy Wound Manage. 2002;48:30-36.

8. Piérard GE, Seité S, Hermanns-Lê T, et al. The skin landscape in diabetes mellitus. Focus on dermocosmetic management. Clin. Cosmet. Investig. Dermatol. 2013;6:127-135. https://doi.org/10.2147/CCID.S43141

9. Polaskova J, Pavlackova J, Vltavska P, et al. Moisturizing effect of topical cosmetic products applied to dry skin. J. Cosmet. Sci. 2013;64:329-340.

10. Seite S, Khemis A, Rougier A, et al. Importance of treatment of skin xerosis in diabetes. J. Eur. Acad. Dermatol. Venereol. 2011;25:607-609. https://doi.org/10.1111/j.1468-3083.2010.03807.x

11. Papanas N, Papazoglou D, Papatheodorou K, et al. Evaluation of a new foam to increase skin hydration of the foot in type 2 diabetes: a pilot study. Int. Wound J. 2011;8:297-300. https://doi.org/10.1111/j.1742-481X.2011.00786.x

X. PHYSICAL EXAMINATION OF THE SKIN AT SUBCUTANEOUS INSULIN INJECTION SITES IN PRIMARY AND SECONDARY PREVENTION OF LIPOHYPERTROPHY

1. Barola A, Tiwari P, Bhansali A, et al. Insulin-related lipohypertrophy: lipogenic action or tissue trauma? Front. Endocrinol. (Lausanne). 2018;9:638. https://doi.org/10.3389/fendo.2018.00638

2. Gentile S, Guarino G, Della Corte T. AMD-OSDI Study Group. Bruising: A neglected, though patient-relevant complication of insulin injections coming to light from a real-life nationwide survey. Diabetes Ther. 2021;12(4):1143-1157. https://doi.org/10.1007/s13300-021-01026-w

3. Hashem R, Mulnier H, Ghazaleh HA, et al. Characteristics and morphology of lipohypertrophic lesions in adults with type 1 diabetes with ultrasound screening: an exploratory observational study. BMJ Open Diabetes Res. Care. 2021;9(2):1-9. https://doi.org/10.1136/bmjdrc-2021-002553

4. Chowdhury TA, Escudier V. Poor glycaemic control caused by insulin induced lipohypertrophy. Br. Med. J. 2003;327(7411):383-384. https://doi.org/10.1136/bmj.327.7411.383

5. Gupta SS, Gupta KS, Gathe SS, et al. Clinical implications of lipohypertrophy among people with type 1 diabetes in India. Diabetes Technol. Ther. 2018;20(7):483-491. https://doi.org/10.1089/dia.2018.0074

6. Ariza-Andraca CR, Altamirano-Bustamante E, Frati-Munari AC, et al. Delayed insulin absorption due to subcutaneous edema. Arch. Invest. Med. 1991;22:229-233.

7. Gentile S, Guarino G, Della Corte T, et al. AMD-OSDI Study Group on Injection Technique, Nefrocenter Research and Nyx Start-Up. Role of structured education in reducing lypodistrophy and its metabolic complications in insulin-treated people with type 2 diabetes: a randomized multicenter case-control study. Diabetes Ther. 2021;12(5):1379-1398. https://doi.org/10.1007/s13300-021-01006-0

8. Barnard-Kelly KD, Mahoney E, Baccari L, et al. Injection technique: development of a novel questionnaire and user guide. Diabetes Spectr. 2021;34(2):156-165. https://doi.org/10.2337/ds20-0054

9. Campinos C, Le Floch JP, Petit C, et al. An effective intervention for diabetic lipohypertrophy: results of a randomized, controlled, prospective multicenter study in France. Diabetes Technol. Ther. 2017;19:623-632. https://doi.org/10.1089/dia.2017.0165

10. Gentile S, Strollo F, Guarino G, et al. Factors hindering correct identification of unapparent lipohypertrophy. J. Diabetes Metab. Disord. Control. 2016;3(2):42-47. https://doi.org/10.15406/jdmdc.2016.03.00065

11. Gentile S, Guarino G, Guida P, et al. A suitable palpation technique allows to identify skin lipohypertrophic lesions in insulin-treated people with diabetes. Springerplus. 2016;5(5):563-570. https://doi.org/10.1186/s40064-016-1978-y

12. Frid AH, Kreugel G, Grassi G, et al. New insulin delivery recommendations. Mayo Clin. Proc. 2016;91(9):1231-1255. https://doi.org/10.1016/j.mayocp.2016.06.010

13. Frid AH, Hirsch LJ, Menchior AR, et al. Worldwide injection technique questionnaire study: injecting complications and the role of the professional. Mayo Clin. Proc. 2016;91(9):1224-1230. https://doi.org/10.1016/j.mayocp.2016.06.012

14. Regulation of the Minister of Health of February 28, 2017 on the kind and scope of preventive, diagnostic, treatment, and rehabilitation services provided by a nurse or midwife independently, without a medical order (Journal of Laws 2017, item 497).

15. Chen L, Xing Q, Li J, et al. Injection technique education in patients with diabetes injecting insulin into areas of lipohypertrophy: a randomized controlled trial. Diabetes Ther. 2021;12 (3):813-826. https://doi.org/10.1007/s13300-021-01013-1

16. Shen M, Shi Y, Zheng S, et al. Systematic survey of physicians’ insights into lipohypertrophy. Front. Public Health. 2021;23(9):738179. https://doi.org/10.3389/fpubh.2021.738179

17. Young RJ, Hannan WJ, Frier BM, et al. Diabetic lipohypertrophy delays insulin absorption. Diabetes Care. 1984;7:479-480. https://doi.org/10.2337/diacare.7.5.479

18. Ji L, Sun Z, Li Q, et al. Lipohypertrophy in China: prevalence, risk factors, insulin consumption, and clinical impact. Diabetes Technol. Ther. 2017;19(1):61-67. https://doi.org/10.1089/dia.2016.0334

XI. ORAL GLUCOSE TOLERANCE TEST (OGTT)

1. Bogdanet D, O’Shea P, Lyons C, et al. The oral glucose tolerance test – is it time for a change? – A literature review with an emphasis on pregnancy. J. Clin. Med. 2020;9(11):3451:1-22. https://doi.org/10.3390/jcm9113451

2. American Diabetes Association Professional Practice Committee. 2. Diagnosis and classification of diabetes: standards of care in diabetes – 2025. Diabetes Care. 2025;48(Suppl.1):S27-S49. https://doi.org/10.2337/dc25-S002

3. Management of type 2 diabetes: A handbook for general practice. The Royal Australian College of General Practitioners. East Melbourne, Vic: RACGP, 2020.

4. Araszkiewicz A, Borys S, Broncel M, et al. Standards of care in diabetes. The position of Diabetes Poland – 2025. Curr. Top. Diabet. 2025;5(1):1-157. https://doi.org/10.5114/ctd/203685

5. Scarpellini E, Arts J, Karamanolis G, et al. International consensus on the diagnosis and management of dumping syndrom. Nat. Rev. Endocrinol. 2020;16(8):448-466. https://doi.org/10.1038/s41574-020-0357-5 Jagannathan R, Neves JS, Dorcely B, et al. The oral glucose tolerance test: 100 years later. Diabetes Metab. Syndr. Obes. 2020;13:3787-3805. https://doi.org/10.2147/DMSO.S246062

6. Standardization of the oral glucose tolerance test. Report of the Committee on Statistics of the American Diabetes Association June 14, 1968. Diabetes. 1969;18 (5):299-307. https://doi.org/10.2337/diab.18.5.299

7. Regulation of the Minister of Health of January 18, 2018 on the list of active ingredients contained in drugs, foodstuffs intended for particular nutritional use and medical devices prescribed by nurses and midwives and the list of diagnostic tests which nurses and midwives are authorized to issue referral for (Journal of Laws 2018. 299).

XII. MEASUREMENT OF THE LEVEL OF KETONE BODIES IN CAPILLARY BLOOD USING A GLUCOSE METER

1. Araszkiewicz A, Borys S, Broncel M, et al. Standards of care in diabetes. The position of Diabetes Poland – 2025. Curr. Top. Diabet. 2025;5(1):1-157. https://doi.org/10.5114/ctd/203685

2. American Diabetes Association Professional Practice Committee. 4. Comprehensive medical evaluation and assessment of comorbidities: standards of care in diabetes – 2025. Diabetes Care. 2025;48(Suppl.1):S59-S85. https://doi.org/10.2337/dc25-S004

3. Kilpatrick ES, Butler AE, Ostlundh L, et al. Erratum. Controversies around the measurement of blood ketones to diagnose and manage diabetic ketoacidosis. Diabetes Care. 2022;45(6):1490. https://doi.org/10.2337/dc22-er06a

4. Szewczyk A, Tobiasz-Kałkun N, Stefanowicz-Bielska A, et al. Practical guidelines for nursing and midwifery diabetes care – 2020. A position of the Polish Federation for Education in Diabetology. Pielęg. XXI wieku. 2020;3(72): 184-207. https://doi.org/10.2478/pielxxiw-2020-0022

5. Song C, Dhaliwal S, Bapat P, et al. Capillary blood ketone level and the prediction of future diabetic ketoacidosis risk in type 1 diabetes. Diabetes Care. 2023;72(Suppl.1):530-P. https://doi.org/10.2337/dc23-0840

6. Optium Xido Neo. Blood glucose monitoring system. User guide. Accessed: 2025-06-03. https://freestyleserver.com/Payloads/IFU/2024/q3/ART47206-001_rev-B-web.pdf

7. Cherubini V, Grimsmann JM, Åkesson K, et al. Temporal trends in diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes between 2006 and 2016: results from 13 countries in three continents. Diabetologia. 2020;63:1530-1541. https://doi.org/10.1007/s00125-020-05152-1

8. Alonso GT, Coakley A, Pyle L, et al. Diabetic ketoacidosis at diagnosis of type 1 diabetes in Colorado children, 2010–2017. Diabetes Care. 2020;43:117-121. https://doi.org/10.2337/dc19-0428

9. Aye T, Mazaika PK, Mauras N, et al. Impact of early diabetic ketoacidosis on the developing brain. Diabetes Care. 2019;42:443-449. https://doi.org/10.2337/dc18-1405

10. Kościelniak-Merak B, Tomasik P. Parameters useful when diagnosing metabolic acidosis – anion gap, osmol gap and bicarbonate gap. Practical Medicine. Pediatrics. 2016;3:97-107.

11. Ho J, Rosolowsky E, Pacaud D, et al. Diabetic ketoacidosis at type 1 diabetes diagnosis in children during the COVID-19 pandemic. Pediatr. Diabetes. 2021;22(4):552-557. https://doi.org/10.1111/pedi.13205

12. Szypowska A, Ramotowska A, Grzechnik-Gryziak M, et al. High frequency of diabetic ketoacidosis in children with newly diagnosed type 1 diabetes. J. Diabetes Res. 2016;1(5):298-300. https://doi.org/10.1155/2016/9582793

13. NICE 2021. Terms and conditions. Notice of rights. Accessed: 2025-06-07. https://www.nice.org.uk/terms-and-conditions#notice-of-rights

XIII. DETERMINATION OF KETONE BODY AND GLUCOSE LEVELS IN URINE

1. Kościelniak-Merak B, Tomasik P. Parameters useful when diagnosing metabolic acidosis – anion gap, osmol gap and bicarbonate gap. Practical Medicine. Pediatrics. 2016;3:97-107.

2. Araszkiewicz A, Borys S, Broncel M, et al. Standards of care in diabetes. The position of Diabetes Poland – 2025. Curr. Top. Diabet. 2025;5(1):1-157. https://doi.org/10.5114/ctd/203685

3. Lim K, Kang M, Park J. Association between fasting ketonuria and advanced liver fibrosis in non-alcoholic fatty liver disease patients without prediabetes and diabetes mellitus. Nutrients. 2021;13(10):3400. https://doi.org/10.3390/nu13103400

4. Zhong VW, Juhaeri J, Mayer-Davis EJ. Trends in hospital admission for diabetic ketoacidosis in adults with type 1 and type 2 diabetes in England, 1998–2013: a retrospective cohort study. Diabetes Care. 2018;41:1870-1877. https://doi.org/10.2337/dc17-1583

5. American Diabetes Association Professional Practice Committee. 4. Comprehensive medical evaluation and assessment of comorbidities: standards of care in diabetes–2025. Diabetes Care. 2025;48(Suppl.1):S59-S85. https://doi.org/10.2337/dc25-S004

6. Hermanides J, Wentholt IM, Hart AA, et al. No apparent local effect of insulin on microdialysis continuous glucose – monitoring measurements. Diabetes Care. 2008;31(6):1120-1123. https://doi.org/10.2337/dc08-0145

7. Kim G, Lee SG, Lee BW, et al. Spontaneous ketonuria and risk of incident diabetes: a 12 year prospective study. Diabetologia. 2019;62(5):779-788. https://doi.org/10.1007/s00125-019-4829-x

8. National Institute for Health and Care Excellence 2021. Terms and conditions. Notice of rights. Accessed: 2025-06-04. https://www.nice.org.uk/terms-and-conditions#notice-of-rights

9. Kilpatrick ES, Butler AE, Saeed S, et al. The effectiveness of blood glucose and blood ketone measurement in identifying significant acidosis in diabetic ketoacidosis patients. Diabetol. Metab. Syndr. 2023;15(1):198. https://doi.org/10.1186/s13098-023-01176-w

10. Wierusz-Wysocka B, Zozulińska-Ziółkiewicz D. Management of emergency and special conditions in patients with diabetes. Gdańsk: Via Medica; 2011, p. 1-5:41-50.

XIV. GENERAL GUIDELINES REGARDING SKIN – PENETRATING PROCEDURES

1. The Act of 5 December 2008 on prevention and control of infections and infectious diseases in humans (Journal of Laws 2008 no. 234, item 1570, as amended).

2. Frid AH, Kreugel G, Grassi G, et al. New insulin delivery recommendations. Mayo Clin. Proc. 2016;91(9):1231-1255. https://doi.org/10.1016/j.mayocp.2016.06.010

3. Donihi AC, DiNardo MM, DeVita MA, et al. Use of a standardized protocol to decrease medication errors and adverse events related to sliding scale insulin. Qual. Saf. Health Care. 2006;15(2):89-91. https://doi.org/10.1136/qshc.2005.014381

4. Abdollahi M, Ayar A, Kouhpeikar H, et al. Interfering effect of alcohol swabbing on capillary blood glucose concentration using a glucometer: a brief report. Mod. Care J. 2024;22(1):e145591. https://doi.org/10.5812/mcj-145591

5. Jonca M, Krotki F, Tomasik P. The effect of disinfecting procedure on the glucose concentration using a personal glucose meter. Prim. Care Diabetes. 2021;15(5):848-852. https://doi.org/10.1016/j.pcd.2021.05.010

6. Hoffman MSF, McKeage JW, Xu J, et al. Minimally invasive capillary blood sampling methods. Expert Rev. Med. Devices. 2023;20(1):5-16. https://doi.org/10.1080/17434440.2023.2170783

7. Boyce JM, Pittet D. Guideline for hand hygiene in health – care settings: recommendations of the Healthcare Infections Control Practices Advisory Committee and HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Infect. Control. Hosp. Epidemiol. 2002;23(Suppl.12):S3-40. https://doi.org/10.1086/503164

8. Notice of the Minister of Health of 6 September 2024 on accreditation standards for healthcare services in the category of inpatient and 24-hour hospital care.

XV. ORAL ANTIHYPERGLYCEMIC AGENT ADMINISTRATION GUIDELINES

1. American Diabetes Association Professional Practice Committee. 9. Pharmacologic approaches to glycemic treatment: standards of care in diabetes – 2025. Diabetes Care. 2025;48(Suppl.1):S181-S206. https://doi.org/10.2337/dc25-S009

2. Araszkiewicz A, Borys S, Broncel M, et al. Standards of care in diabetes. The position of Diabetes Poland – 2025. Curr. Top. Diabet. 2025;5(1):1-157. https://doi.org/10.5114/ctd/203685

3. DeFronzo RA, Ferrannini E, Groop L, et al. Type 2 diabetes mellitus. Nat. Rev. Dis. Primers. 2015;1:15019. https://doi.org/10.1038/nrdp.2015.19

4. Nauck MA, Meier JJ. Incretin hormones: Their role in health and disease. Diabetes Obes. Metab. 2018;20(Suppl 1):5-21. https://doi.org/10.1111/dom.13129

5. Zinman B, Lachin JM, Inzucchi SE. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N. Engl. J. Med. 2016;374(11):1094. https://doi.org/10.1056/NEJMc1600827

6. Kostrzewa-Zabłocka E. Pharmaceutical methods. Oral Medication Treatment. In: Szewczyk A. (ed.) Diabetes nursing. Warsaw: PZWL; 2019.

7. Pawlaczyk K, Czekalski S, Zozulińska-Ziółkiewicz D. Modern diabetes treatment –non-insulin medication. Warsaw: Medical Education; 2020.

8. Evans M, Engberg S, Faurby M, et al. Adherence to and persistence with antidiabetic medications and associations with clinical and economic outcomes in people with type 2 diabetes mellitus: a systematic literature review. Diabetes Obes. Metab. 2022;24(3):377-390. https://doi.org/10.1111/dom.14603

9. Davidson MA, Mattison DR, Azoulay L, et al. Thiazolidinedione drugs in the treatment of type 2 diabetes mellitus: past, present and future. Crit. Rev. Toxicol. 2018;48:52-108. https://doi.org/10.1080/10408444.2017.1351420

10. Buse JB, Wexler DJ, Tsapas A, et al. 2019 Update to: Management of hyperglycemia in type 2 diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2020;43(2):487-493. https://doi.org/10.2337/dci19-0066

11. Cheen MHH, Tan YZ, Oh LF, et al. Prevalence of and factors associated with primary medication non-adherence in chronic disease: a systematic review and meta-analysis. Int. J. Clin. Pract. 2019;73(6):e13350. https://doi.org/10.1111/ijcp.13350

12. Clodi M, Abrahamian H, Brath H, et al. Antihyperglycemic treatment guidelines for diabetes mellitus type 2. Wien. Klin. Wochenschr. 2019;131:27-37. https://doi.org/10.1007/s00508-019-1471-z

13. Engler C, Leo M, Pfeifer B, et al. Long-term trends in the prescription of antidiabetic drugs: real-world evidence from the Diabetes Registry Tyrol 2012-2018. BMJ Open Diabetes Res. Care. 2020;8:e001279. https://doi.org/10.1136/bmjdrc-2020-001279

XVI. GUIDELINES FOR USING INFORMATION AND COMMUNICATION TECHNOLOGIES IN NURSING DIABETES CARE

1. College of Nurses of Ontario. Telepractice guideline. 2020. Accessed: 2025-06-22. https://www.cno.org/globalassets/docs/prac/41041_telephone.pdf

2. Crawley R, Kuchta P. Telehealth Nursing Practice Special Interest Group. A telehealth manager’s toolkit. American Academy of Ambulatory Care Nursing. 2012:1-70.

3. Series ICN Regulation. „ICN framework of competencies for the nurse specialist.” 2009. Accessed: 2025-06-10. https://www.commonwealthnurses.org/ARC/Documents/ Resources/ICN%20Nursing%20care%20continuum.pdf

4. Kilańska D, Grabowska H, Gaworska-Krzemińska A. E-zdrowie. Introduction to the use of ICT in nursing. Warsaw: PZWL; 2017.

5. NSCN. Nova Scotia College of Nursing. Practice guidelines for nurses. Telenursing. 2023. Accessed: 2025-06-10. https://www.nscn.ca/professional-practice/practice-support/practice-support-tools/technology/telenursing-practice-guideline-nurses

6. Poreddi V, Kathyayani BV, Hatti NM, et al. NIMHANS-telenursing practice guidelines. Bengaluru 2020. Accessed: 2025-06-10. https://nimhans.co.in/wp-content/uploads/ 2021/09/TeleNursing-Practice-Guideline-2020.pdf

7. Regulation of the Minister of Health of 23 September 2019 amending the Regulation on guaranteed specialist outpatient care services. (Journal of Laws 2019, item 1864).

8. Bujnowska-Fedak MM, Tomczak M. Innovative telemedicine applications and e-health services in the care of older patients. Public Health and Governance. 2013;11(4):302-317. https://doi.org/10.4467/20842627OZ.14.030.2169

9. Report „How to use the potential of telemedicine in diabetology” by the Telemedicine Working Group Foundation in cooperation with experts from Diabetes Poland and representatives of the diabetes nursing community. Warsaw 2021.

10. Wilson LS, Maeder AJ. Recent directions in telemedicine: review of trends in research and practice. Healthc. Inform. Res. 2015;21(4):213-222. https://doi.org/10.4258/hir.2015.21.4.213

11. Souza-Junior VD, Mendes IAC, Mazzo A, et al. Application of telenursing in nursing practice: an integrative literature review. Appl. Nurs. Res. 2016;29:254-260. https://doi.org/10.1016/j.apnr.2015.05.005

12. Kord Z, Fereidouni Z, Mirzaee MS, et al. Telenursing home care and COVID-19: a qualitative study. BMJ Support Palliat. Care. 2024;14:e992-e1000. https://doi.org/10.1136/bmjspcare-2021-003001

13. Bingham JM, Black M, Anderson EJ, et al. Impact of telehealth interventions on medication adherence for patients with type 2 diabetes, hypertension, and/or dyslipidemia: a systematic review. Ann Pharmacother. 2021;55(5):637-649. https://doi.org/10.1177/1060028020950726

14. Aminuddin HB, Jiao N, Jiang Y, et al. Effectiveness of smartphone-based self-management interventions on self-efficacy, self-care activities, health-related quality of life and clinical outcomes in patients with type 2 diabetes: a systematic review and meta-analysis. Int. J. Nurs. Stud. 2021;116:103286. https://doi.org/10.1016/j.ijnurstu.2019.02.003

15. Roussel J. Competencies for the clinical nurse specialist and nurse practitioner in Canada. In: Staples E, Pilon R, Hannon RA, ed. Canadian perspectives on advanced practice nursing. Toronto (ON): Canadian Scholars; 2020, p. 74-85.

16. Yang S, Jiang Q, Li H. The role of telenursing in the management of diabetes: a systematic review and meta‐analysis. Public Health Nurs. 2019;36(4):575-586. https://doi.org/10.1111/phn.12603

17. Mamaghani HA, Tabrizi FJ, Seyedrasooli A, et al. Effect of empowerment program with and without telenursing on self-efficacy and glycosylated hemoglobin index of patients with type 2 diabetes: a randomized clinical trial. Scand. J. Caring Sci. 2020;10(1):22-28. https://doi.org/10.34172/jcs.2021.001

18. Kotsani K, Antonopoulou V, Kountouri A, et al. The role of telenursing in the management of diabetes type 1: a randomized controlled trial. Int. J. Nurs. Stud. 2018;80:29-35. https://doi.org/10.1016/j.ijnurstu.2018.01.003

19. Biermann E, Dietrich W, Rihl J, et al. Are there time and cost savings by using telemanagement for patients on intensified insulin therapy? A randomised, controlled trial. Comput. Methods Programs Biomed. 2002;69(2):137-146. https://doi.org/10.1016/s0169-2607(02)00037-8

20. American Diabetes Association Professional Practice Committee; 1. Improving care and promoting health in populations: standards of care in diabetes-2025. Diabetes Care. 2025;48(Suppl.1):S14-S26. https://doi.org/10.2337/dc25-S001

21. Kilańska D. The nurse during the time of coronavirus. Teleappointments. Warsaw: PZWL; 2020.

22. Decision of the National Health Fund President (no.182/2019/DSOZ) on specifying the conditions for concluding and implementing contracts for the provision of health services of the specialist outpatient care type.

23. Kusnanto, Widyanata K, Suprajitno, Arifin H. DM-calendar app as a diabetes self-management education on adult type 2 diabetes mellitus: a randomized controlled trial. J. Diabetes Metab. Disord. 2019;18(2):557-563. https://doi.org/10.1007/s40200-019-00468-1

24. Kim Y, Park JE, Lee BW, et al. Comparative effectiveness of telemonitoring versus usual care for type 2 diabetes: a systematic review and meta-analysis. J. Telemed. Telecare. 2019;25(10):587-601. https://doi.org/10.1177/1357633X18782599

XVII. GUIDELINES ON THE PREVENTION OF TYPE 1 DIABETES

1. Bonifacio E, Weiß A, Winkler C, et al. An age-related exponential decline in the risk of multiple islet autoantibody seroconversion during childhood. Diabetes Care. 2021;44(10):2260-2268. https://doi.org/10.2337/dc20-2122

2. Redondo MJ, Morgan NG. Heterogeneity and endotypes in type 1 diabetes mellitus. Nat. Rev. Endocrinol. 2023;19(9):542-554. https://doi.org/10.1038/s41574-023-00853-0

3. Chan JC, Lim LL, Wareham NJ, et al. The Lancet Commission on diabetes: using data to transform diabetes care and patient lives. Lancet. 2020;396(10267):2019-2082. https://doi.org/10.1016/S0140-6736(20)32374-6

4. Eisenbarth GS. Trials of „Immunotherapy” to preserve beta-cell function of prediabetic and new-onset patient trials. Curr. Diab. Rep. 2004;4(2):85-86. https://doi.org/10.1007/s11892-004-0061-1

5. Ferrat LA, Vehik K, Sharp SA, et al. A combined risk score enhances prediction of type 1 diabetes among susceptible children. Nat. Med. 2020;26(8):1247-1255. https://doi.org/10.1038/s41591-020-0930-4

6. Simmons KM, Emily K. Sims. Screening and prevention of type 1 diabetes: where are we?. J. Clin. Endocrinol. Metab. 2023;108(12):3067-3079. https://doi.org/10.1210/clinem/dgad328

7. Primavera M, Giannini C, Chiarelli F. Prediction and prevention of type 1 diabetes. Front. Endocrinol. 2020;11:248. https://doi.org/10.3389/fendo.2020.00248

8. Carré A, Vecchio F, Flodström-Tullberg M, et al. Coxsackievirus and type 1 diabetes: diabetogenic mechanisms and implications for prevention. Endocr. Rev. 2023;44(4):737-751. https://doi.org/10.1210/endrev/bnad007

9. Harvey J. Vitamin D in the prevention of type 1 diabetes: would increasing food fortification reduce the incidence?. Br. J. Diabetes. 2023;23(1):39-44. https://doi.org/10.15277/bjd.2023.405

10. Hyppönen E, Läärä E, Reunanen A, et al. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet. 2001;358(9292):1500-1503. https://doi.org/10.1016/S0140-6736(01)06580-1

11. Jacobsen LM, Schatz DA, Herold KC, et al. Prevention of type 1 diabetes. In: Lawrence JM, Casagrande SS, Herman WH, Wexler DJ, Cefalu WT (ed.). Diabetes in America. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); 2024. Accessed: 2025-06-10. https://www.ncbi.nlm.nih.gov/books/NBK604182

12. Chen X, Affinati AH, Lee Y, et al. Immune checkpoint inhibitors and risk of type 1 diabetes. Diabetes Care. 2022;45(5):1170-1176. https://doi.org/10.2337/dc21-2213

13. Jing Z, Li Y, Ma Y, et al. Leverage biomaterials to modulate immunity for type 1 diabetes. Front. Immunol. 2022;13:997287. https://doi.org/10.3389/fimmu.2022.997287

14. LeFevre JD, Cyriac SL, Tokmic A, et al. Anti-CD3 monoclonal antibodies for the prevention and treatment of type 1 diabetes: a literature review. Am. J. Health Syst. Pharm. 2022;79(23):2099-2117. https://doi.org/10.1093/ajhp/zxac244

15. Johnson RK, Vanderlinden LA, DeFelice BC, et al. Metabolomics-related nutrient patterns at seroconversion and risk of progression to type 1 diabetes. Pediatr. Diabetes. 2020;21(7):1202-1209. https://doi.org/10.1111/pedi.13085

16. Hakola L, Mramba LK, Uusitalo U, et al. Intake of B vitamins and the risk of developing islet autoimmunity and type 1 diabetes in the TEDDY study. Eur. J. Nutr. 2024;63:1329-1338. https://doi.org/10.1007/s00394-024-03346-6

17. Hoffmann L, Kohls M, Arnolds S, et al. EDENT1FI Master Protocol for screening of presymptomatic early-stage type 1 diabetes in children and adolescents. BMJ Open. 2025;15(1):e088522. https://doi.org/10.1136/bmjopen-2024-088522

18. Narayan K, Mikler K, Maguire A, et al. The current landscape for screening and monitoring of early‐stage type 1 diabetes. J. Paediatr. Child Health. 2025;61(5):676-684. https://doi.org/10.1111/jpc.70016

19. Hornik B, Przeorska-Najgebauer T, Włodarczyk I. The role of the nurse in the prevention of type 1 diabetes. Ann. UMCS Sect. D. 2005;60(2):154-157.

20. Allen L, Dayan C. Immunotherapy for type 1 diabetes. Br. Med. Bull. 2021;140(1):76-90. https://doi.org/10.1093/bmb/ldab027

21. Dayan CM, Besser RE, Oram RA, et al. Preventing type 1 diabetes in childhood. Science. 2021;373(6554):506-510. https://doi.org/10.1126/science.abi4742

22. Araszkiewicz A, Borys S, Broncel M, et al. Standards of care in diabetes. The position of Diabetes Poland – 2025. Curr. Top. Diabet. 2025;5(1):1-157. https://doi.org/10.5114/ctd/203685

23. Evert AB, Dennison M, Gardner CD, et al. Nutrition therapy for adults with diabetes or prediabetes: a consensus report. Diabetes Care. 2019;42(5):731-754. https://doi.org/10.2337/dci19-0014

24. Dai H, Chen Q, Huang H, et al. The role of nurses in taking care of children with type 1 diabetes. Altern. Ther. Health. Med. 2022; 28(1):107-113.

25. Lahsen HAT, Ragala MEA, Halim K, et al. Investigation of the therapeutic education effect on glycemic control and quality of life of children and adolescents with type-1 diabetes mellitus: A non-randomized controlled study. J. Educ. Health Promot. 2024;13(1):228. https://doi.org/10.4103/jehp.jehp_1258_23

Mameli C, Triolo TM, Chiarelli F, et al. Lessons and gaps in the prediction and prevention of type 1 diabetes. Pharmacol. Res. 2023;193:106792. https://doi.org/10.1016/j.phrs.2023.106792

XVIII. GUIDELINES ON THE PREVENTION OF TYPE 2 DIABETES

1. Tuomilehto J, Uusitupa M, Gregg EW, et al. Type 2 diabetes prevention programs from proof-of-concept trials to national intervention and beyond. J. Clin. Med. 2023;12(5): 1876. https://doi.org/10.3390/jcm12051876

2. Chan JCN, Lim LL, Wareham NJ, et al. The Lancet Commission on diabetes: using data to transform diabetes care and patient lives. Lancet. 2020;396(10267):2019-2082. https://doi.org/10.1016/S0140-6736(20)32374-6

3. Albright AL, Gregg EW. Preventing type 2 diabetes in communities across the US: the National Diabetes Prevention Program. Am. J. Prev. Med. 2013;44(4):S346-S351. https://doi.org/10.1016/j.amepre.2012.12.009

4. Haw JS, Galaviz KI, Straus AN, et al. Long-term sustainability of diabetes prevention approaches: a systematic review and meta-analysis of randomized clinical trials. JAMA Intern. Med. 2017;177:1808-1817. https://doi.org/10.1001/jamainternmed.2017.6040

5. Malecki HL, Gollie JM, Scholten J. Physical activity, exercise, whole health, and integrative health coaching. Phys. Med. Rehabil. Clin. N. Am. 2020;31(4):649-663. https://doi.org/10.1016/j.pmr.2020.06.001

6. Golovaty I, Ritchie ND, Tuomilehto J, et al. Two decades of diabetes prevention efforts: a call to innovate and revitalize our approach to lifestyle change. Diabetes Diabetes Res. Clin. Pract. 2023;198:110195. https://doi.org/10.1016/j.diabres.2022.110195

7. Hornik B, Kopczyńska E, Przeorska-Najgebauer T. Role of the nurse in a prevention of type 2 diabetes. Ann. UMCS Sect. D. 2005;60(2):158-162.

8. Bun R, Tounkara B, Leruste S, et al. Prediabetes in a French overseas territory: clinical characteristics, risk factors, and implications for type 2 diabetes prevention. Prev. Med. Rep. 2024;47:102893. https://doi.org/10.1016/j.pmedr.2024.102893

9. Araszkiewicz A, Borys S, Broncel M, et al. Standards of care in diabetes. The position of Diabetes Poland – 2025. Curr. Top. Diabet. 2025;5(1):1-157. https://doi.org/10.5114/ctd/203685

10. Rintamäki R, Rautio N, Peltonen M, et al. Long-term outcomes of lifestyle intervention to prevent type 2 diabetes in people at high risk in primary health care. Prim. Care Diabetes. 2021;15(3):444-450. https://doi.org/10.1016/j.pcd.2021.03.002

11. Diabetes Prevention Program Research Group. Longterm effects of metformin on diabetes prevention: identification of subgroups that benefited most in the diabetes prevention program and diabetes prevention program outcomes study. Diabetes Care. 2019;42:601-608. https://doi.org/10.2337/dc18-1970

12. le Roux CW, Astrup A, Fujioka K, et al. 3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double-blind trial. Lancet. 2017;389(10077):1399-1409. https://doi.org/10.1016/S0140-6736(17)30069-7

13. Gilis-Januszewska A, Lindström J, Tuomilehto J, et al. Sustained diabetes risk reduction after real life and primary health care setting implementation of the diabetes in Europe prevention using lifestyle, physical activity and nutritional intervention (DE-PLAN) project. BMC Public Health. 2017;17:1-7. https://doi.org/10.1186/s12889-017-4104-3

14. Yost O, DeJonckheere M, Stonebraker S, et al. Continuous glucose monitoring with low-carbohydrate diet coaching in adults with prediabetes: mixed methods pilot study. JMIR Diabetes. 2020;5(4):e21551. https://doi.org/10.2196/21551

15. Sussman JB, Kent DM, Nelson JP, et al. Improving diabetes prevention with benefit based tailored treatment: risk based reanalysis of Diabetes Prevention Program. BMJ. 2015;350:h454. https://doi.org/10.1136/bmj.h454

16. Raynor HA, Davidson PG, Burns H, et al. Medical nutrition therapy and weight loss questions for the evidence analysis library prevention of type 2 diabetes project: systematic reviews. J. Acad. Nutr. Diet. 2017;117(10):1578-1611. https://doi.org/10.1016/j.jand.2017.06.361

17. Evert AB, Dennison M, Gardner CD, et al. Nutrition therapy for adults with diabetes or prediabetes: a consensus report. Diabetes Care. 2019;42(5):731-754. https://doi.org/10.2337/dci19-0014

18. Seyoum, T, Tesfaye S, Shiferaw Y, et al. Knowledge of behavioral risk factors for type 2 diabetes mellitus and its associated factors among women of reproductive age. PloS One. 2025;20(2):e0275700. https://doi.org/10.1371/journal.pone.0275700

19. Jastreboff, AM, le Roux CW, Stefanski A, et al. Tirzepatide for obesity treatment and diabetes prevention. N. Engl. J. Med. 2025;392(10):958-971. https://doi.org/10.1056/NEJMoa2410819

20. Chai X, Wang Y, Yin X, et al. Effects of lifestyle interventions on the prevention of type 2 diabetes and reversion to normoglycemia by prediabetes phenotype: a systematic review and meta-analysis of randomized controlled trials. Diabetes Metab. Syndr. 2025;19(1):103184. https://doi.org/10.1016/j.dsx.2025.103184

21. Peer N, Balakrishna Y, Durao S. Screening for type 2 diabetes mellitus. Cochrane Database Syst. Rev. 2020;5(5):CD005266. https://doi.org/10.1002/14651858.CD005266.pub2

22. Marsim E, Prisma FA, Prianggi H. Meta-analysis: application of health belief model on the tertiary prevention of type 2 diabetes mellitus. J. Health Promot. Behav. 2021;6(4):284-297. https://thejhpb.com/index.php/thejhpb/article/view/338

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2025-12-09

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Vol. 24 No. 4(93) (2025): Pielęgniarstwo XXI wieku

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Szewczyk, A., Tobiasz-Kałkun, N., Stefanowicz-Bielska, A., Kobos, E., Kapuściok , J., Karczewska, A., Mazuryk, K., & Hornik, B. (2025). Practical guidelines for nursing and midwifery diabetes care – 2026. A position of the Polish Federation for Education in Diabetology. Nursing in the 21st Century, 24(4(93), 347-400. https://doi.org/10.12923/pielxxiw-2025-0034