Effectiveness of Nurse-Led Counseling in the Prevention of Type 2 Diabetes among Hypertensive Adults: A Systematic Review and Meta-Analysis

Background: Type 2 diabetes mellitus represents a major global health challenge, with hypertensive adults facing significantly elevated diabetes risk. While nurse-led interventions show promise in chronic disease management, limited evidence exists regarding their effectiveness in diabetes prevention among hypertensive populations. This systematic review and meta-analysis evaluated nurse-led counseling interventions for preventing type 2 diabetes in hypertensive adults.

Methods: A systematic search across five databases (CINAHL, Cochrane, Embase, MEDLINE, Scopus) from January 2000 to August 2025 identified eligible randomized controlled trials, cluster randomized trials, and quasi-experimental studies. Two reviewers independently screened studies, extracted data, and assessed quality using Cochrane Risk of Bias 2.0 and ROBINS-I tools. Meta-analysis employed random-effects models with risk ratios for dichotomous outcomes and mean differences for continuous outcomes.

Results: Twelve studies involving 3,456 participants met inclusion criteria. Nurse-led counseling interventions significantly reduced type 2 diabetes incidence by 46% compared to usual care (pooled risk ratio = 0.54; 95% CI: 0.42–0.71; p < 0.0001; I² = 23%). Secondary outcomes showed significant improvements: HbA1c reduction of 0.34% (95% CI: -0.52 to -0.16), BMI reduction of 1.2 kg/m² (95% CI: -1.8 to -0.6), and enhanced physical activity (standardized mean difference: 0.67; 95% CI: 0.34–1.00). Longer-duration interventions (≥12 months) with face-to-face delivery demonstrated more sustained effects.

Conclusions: Nurse-led counseling interventions effectively prevent type 2 diabetes among hypertensive adults, demonstrating clinically significant reductions in diabetes incidence alongside improvements in glycemic control and lifestyle behaviors. Healthcare systems should integrate these accessible, scalable interventions into routine hypertension care with appropriate nurse training and support.