Effectiveness of Patients' Education and Telenursing Follow-Ups on Self-Care Practices of Patients With Diabetes Mellitus: Cross-Sectional and Quasi-Experimental Study.

The phase II intervention had no control group, so the score changes cannot be confidently attributed to the education and telenursing package. Knowledge and self-care practice results relied partly on patients' own reports, so patients may have reported what they thought was expected. Researchers could not objectively measure exercise, nutrition, or blood glucose outside the clinic. The study was done in one Egyptian outpatient diabetes clinic, so results may not apply elsewhere. Phase II selected only 100 patients with the lowest baseline scores, so it does not show how patients with better baseline self-care would respond. Many patients may lack smartphones, internet, or digital literacy. This can limit real-world use of WhatsApp and SMS follow-up. The skills results are reported for 58 patients for insulin preparation and for insulin injection and 100 patients for urine glucose testing, while phase II included 100 patients, so the basis for some skill claims is unclear.

Do not conclude that telenursing follow-ups alone improved diabetes self-care. The patients also received nurse-led educational sessions, booklets, phone calls, SMS, WhatsApp messages, videos, and voice notes, and the study had no control group, so the contribution of any single component cannot be separated.