Impact of a clinical diabetes specialist mentoring programme on type 2 diabetes management among nurses in primary care: a qualitative study

Introduction

Management of type 2 diabetes (T2D) in primary care in Aotearoa New Zealand (NZ) is often suboptimal, with inequitable health outcomes, especially for Māori (Indigenous people of NZ)¹ due to systemic factors such as short 15-min appointment times, insufficient clinical staff, and culturally unsafe training.² In particular, Māori often receive fewer prescriptions for T2D medications,¹ although recent funding of new diabetes medications (SGLT2i/GLP1RA) under special authority and prioritised access for Māori and Pacific peoples aim to lessen this equity gap.³

Due to recent changes in the availability of T2D medications in NZ³ and the variety of quality improvement strategies used across the country,⁴ there is a need for continuing professional development to support clinicians to deliver optimised T2D care. While initiatives to support NZ healthcare professionals to enhance T2D management for their patients have been previously developed, including the Advanced Diabetes Management Course,⁵ such online courses may not meet the needs of all clinicians in primary care where the needs of the role are varied and complex. Specialist diabetes support has previously been shown to increase staff confidence and competence with management of T2D.² Most recently, this has included a nursing-specific diabetes mentoring programme delivered by an experienced non-physician clinical diabetes specialist and the upskilling of nurses in primary care to enhance T2D management with individualised educational skill-based goal setting. However, the importance of this model has never before been evaluated in NZ, particularly including whether nurses felt more confident and capable managing T2D in primary care. Therefore, we aimed to qualitatively evaluate the importance of the clinical diabetes specialist mentoring programme among nurses in primary care and its impact on diabetes knowledge and confidence and access to programme support.

Methods

Results

All six nurses were approached and completed interviews. Of the four nurses involved in the mentoring programme, two nurses self-reported limited knowledge of T2D management, while two others self-reported average knowledge (n = 2). All participants identified that the mentorship was highly beneficial for supporting their knowledge base around T2D management. Reported improvements included enhanced knowledge of diabetes medications (n = 6), interpreting clinical measures (n = 6), and patient-centred communication skills, particularly in using lay terms and clear diagrams (n = 6).

If you draw people a picture on how it works, and what’s happening in their system, and why they’re feeling the way they are, it just makes more sense. (Nurse 3)

Nurses and lead nurses reported feeling supported due to the non-physician diabetes specialist’s accessible and consistent support by phone outside of the clinic visit days (n = 6). Nurses also reported that working with the diabetes specialist was beneficial as they were able to discuss complex cases (n = 5) and found the hands-on one-on-one approach with the specialist useful (n = 3), even after completing other modes of education.

[Referring to a previously completed online advanced diabetes course] … it’s so good, but it just feels like a real brain, you know, like information dump, all the slides, just, you know, stats and everything. And so, it’s a really good reference. And I learned so much from it. But like, with [diabetes specialist] coming out, it’s just so amazing how it just sort of all clicks and like it because you’re seeing patients and it’s actually like a lived, you know, you’re actually seeing it tangible. (Nurse 4)

Nurses also reported increased confidence in patient advocacy, such as medication entitlements for Māori and Pasifika (n = 6), working with continuous glucose monitors (CGMs) (n = 6), interpreting laboratory test results such as HbA1c (n = 6), administering medications (n = 6), patient communication (n = 6), and annual diabetes reviews (n = 5). This improved confidence was perceived to positively impact patient care, with nurses reporting patients’ enhanced access to health care by having a comprehensive review with a nurse without seeing a GP (n = 2), feeling heard (n = 2), and increased follow-ups (n = 2).

They [patients] feel confident that we’re treating them right and how to treat them. (Nurse 2)

A frequently mentioned need was increased time with the diabetes specialist (n = 4). Ongoing development included further training in medication administration (eg rapid-acting insulin) (n = 3), understanding patient entitlements (n = 1), using CGMs (n = 1), knowledge on the pathophysiology of T2D (n = 1), and communicating effectively with patients with prediabetes (n = 1).

The medication for me is still something I struggle with, but I know the others [nurses] are getting better with that. (Nurse 1)

Discussion

Overall, the mentoring programme improved nurses’ self-reported confidence and expertise in key areas of T2D management, with similar improvements also observed by lead nurses within the same clinics. Although rates of nurse-led T2D management in NZ have increased in the past few years,⁸ there is still a gap in knowledge with medication use and clinical profile,⁹ which was also reported in our study. These findings highlight the need for targeted diabetes education to strengthen nurses’ role in effective T2D care.

While initial self-reported knowledge levels varied among participants, all nurses perceived the mentorship as beneficial to their professional development. Self-reported evidence-based practice knowledge is often overestimated, highlighting a discrepancy between perceived and actual knowledge levels.¹⁰ Given the growing need for continuous professional development in diabetes management,¹¹ the results of this study highlight the potential benefits of mentoring programmes. A similar programme in Canada that aimed to upskill nurses in T2D management showed improved knowledge and confidence, particularly in areas such as insulin therapy.¹² Computerised education showed slight improvement in knowledge but no difference in pre and post intervention,¹³ which may indicate the importance of a hands-on approach.

Furthermore, the benefits of mentoring extended beyond diabetes knowledge. Participants reported increased professional confidence, improved patient advocacy with GPs, and a greater sense of support in their roles. Long-term education and mentoring among health professionals have been reported to significantly enhance their confidence and practices in managing T2D.¹⁴ Clinicians reported that limited cultural education and time constraints contributed to inequities in T2D care for Māori,¹⁵ with mentoring potentially bridging these gaps by increased confidence in knowledge and patient advocacy. These findings highlight the multifaceted impact of mentorship, reinforcing its role in leading to a more skilled and motivated nursing workforce.

While this study has the strength of evaluation of nurse education in a real-world clinical setting, we note the limitations of this study (small sample size and lack of diversity and representation with regards to clinic size, type, and regionality) and suggest that a quantitative follow-up is needed to measure the specific impacts of this programme on clinical outcomes across a larger number of clinics. The findings support the need for broader investment in structured diabetes education for nurses, with implications for workforce development policy. Overall, this study adds to the growing body of evidence supporting hands-on mentorship as a key strategy in improving diabetes management. Future research should explore the development of mentoring programmes specifically designed to provide culturally safe care for Māori and Pacific patients.

Supplementary material

Supplementary material is available online.