Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease caused by both genetic and environmental factors. It is characterized by insulin resistance accompanied by a progressive decline in pancreatic $\beta$-cell function. In past decades, changes in lifestyle and diet structure have contributed considerably to increasing global prevalence of T2DM [1]. If not properly managed, T2DM can lead to serious complications, such as diabetic retinopathy, nephropathy, cardiovascular and cerebrovascular diseases [2]. These complications compromise physical health and impose substantial psychological burden and economic pressure on patients.

Traditionally, T2DM has been regarded as a disease that can be controlled but not permanently cured. In recent years, with the improvement of the cognitive level of T2DM and the progress of medical technology, researchers have established a novel method for the prevention and treatment of T2DM, that is, reversing T2DM, and have achieved positive results [3]. The American Diabetes Association (ADA) defines “diabetes remission” as managing glycated hemoglobin A1c (HbA1c) levels 6.5% for at least 3 months in the absence of antidiabetic drugs [4]. A study has found that without intensive blood glucose control within 1 year after diagnosis, the risk of both microvascular and macrovascular complications may continue to increase over the next 5 to 10 years, even if blood glucose control is subsequently improved, and early and proactive intervention can increase the remission rate of T2DM [5].

Patient’s good compliance, disease management skills, and positive attitude towards the disease can be significantly linked with enhanced treatment outcomes and an increased likelihood of recovery [6]. Therefore, approaches that strengthen patient education, enhance knowledge updates, encourage peer support, and integrate comprehensive, multidisciplinary management are widely known as critical components of effective disease care [7]. A previous study have found that multidisciplinary continuous nursing interventions can effectively improve patients’ compliance, support the shift in unhealthy lifestyle attitudes, encourage regular follow-up consultations, and improve self-care knowledge following comprehensive health education. Continuing nursing care provides professional support outside the hospital setting into the home environment of the patients. Continuing care service enables patients to access ongoing guidance and support through diverse out-of-hospital channels, helping them achieve consistent disease care [8].

Despite promising advantages, conventional care for T2DM remains limited due to time constraints. In clinical practice, the traditional “one-to-one” consultation model focuses mainly on medication and brief doctor’s advice, offering an inadequate window for in-depth education regarding disease and long-term self-management. In contrast, the shared outpatient management model is an innovative approach to disease care. In this model, patients participate in extended team-based counseling where patients receive detailed knowledge about T2DM management, participate in discussions between doctors and other patients, and share treatment experiences with other patients facing similar complications [9]. This method is conducive to improving the lifestyle of patients and establishing a good disease management system.

Given the disease background, this study aims to systematically evaluate the clinical efficacy of continuing care services combined with a shared outpatient management model for patients with T2DM. Specifically, it assesses its effect on the remission rate of T2DM and explores its impact on crucial metabolic indicators and self-management behaviors. By evaluating these outcomes, the study intends to provide a scientific basis for optimizing diabetes management strategies and promoting the practical implementation of remission-oriented care in clinical settings.

Diabetes is a chronic metabolic disease and is primarily characterized by persistently increased blood glucose levels. More than 95% of cases are classified as T2DM. If not properly managed, this disease may result in severe complications, such as blindness, renal failure, myocardial infarction, stroke, and lower limb amputation [11, 12]. The pathogenesis of T2DM is strongly associated with genetic predisposition and modifiable lifestyle indicators [13]. The findings of this study indicated that continuous nursing care combined with a shared outpatient management model may play a crucial role in improving relevant patient indicators and overall clinical outcomes in T2DM patients.

The present study shows that this continuing care service, combined with a shared outpatient management model, had favorable effects on several critical clinical indicators, including blood glucose levels, islet function, BMI, and HbA1c. Furthermore, patients receiving this integrated care demonstrated a higher rate of remission. Previous research has shown that impaired islet function in early-stage overweight or obese T2DM patients is often associated with insulin resistance and lipotoxicity [14]. Lifestyle interventions can significantly reduce pancreatic fat deposition and alleviate lipotoxic damage to $\beta$ cells, thereby partially restoring insulin secretion and improving blood glucose control [6]. The results of the current study are consistent with this mechanism. Improvement in patients’ diet, exercise, and medication adherence likely led to better metabolic control and enhanced islet function, ultimately increasing the rate of diabetes remission. The integrated model used in this study may have supported these metabolic improvements by systematically enhancing patients’ adherence to recommended lifestyle and treatment behaviors through sustained nursing support and peer interaction.

The improvements in clinical indicators and metabolic outcomes found in this study were closely linked to enhanced patients’ self-management. Successful diabetes control depends largely on the ability of the patient to maintain long-term behavioral alterations. Previous research has shown that structured interventions aimed at enhancing self-management ability can substantially improve blood glucose levels and maintain healthy behaviors over time [15]. In our study, ongoing nursing care provided continuous professional guidance and personalized education, helping patients reach better health information and translate that into practical daily life activities. Furthermore, the shared outpatient services developed a peer-support environment that encourages free discussion, experience sharing, and emotional support. This interactive and supportive environment may have increased patients’ confidence and self-efficacy in managing their disease. Overall, these factors developed a supportive setting that reinforced positive behavioral changes in patients. In the present study, patients who received continuing care services combined with the shared outpatient management model had significantly higher scores across several domains of diabetes self-management, such as diet, exercise, foot care, blood glucose monitoring, and medication adherence. These observations are consistent with previous findings, which reported that telephone follow-up can improve psychosocial outcomes related to self-management in patients with diabetes [16]. Similarly, another study established a digital diabetes education and management platform using the WeChat application, where healthcare professionals provided disease-related education and explained self-management experiences. After 3 months of follow-up, patients demonstrated considerable improvement in both self-management skills and coping approaches [17].

The results of the present study suggest that continuing care service combined with the shared outpatient management model can effectively improve metabolic indicators, enhance islet function and self-management behaviors, and significantly increase the rate of diabetes remission. Furthermore, group-based interventions and remote follow-up approaches enable more efficient management without increasing clinical workload. More importantly, improvements in blood glucose control, islet function, and self-management ability may contribute to long-term disease control. Patients who achieve disease remission may be able to stop using antidiabetic drugs, which not only improves quality of life but also directly reduces long-term treatment costs. Additionally, strengthening self-management behaviors, particularly regular blood glucose monitoring and medication compliance, may reduce acute medical complications and unplanned hospital visits associated with poor blood glucose control. Consequently, this model can improve overall healthcare resource utilization. Future studies can further quantify the model’s specific benefits in reducing the direct medical- related costs (such as drug expenses, testing costs, and acute care utilization) through prospective cost-effectiveness analysis, to provide a more solid economic basis for its promotion in the broader health care system.

There are some limitations in this study. First, this is a retrospective observational study without random allocation of participants. Although the two groups were comparable at baseline, it is not possible to completely exclude the potential influence of unmeasured or undocumented confounding factors. Variables such as socioeconomic status, family support, initial motivation for behavioral change, and genetic background may have affected the observed outcomes. Second, this study was performed at a single center, whose management approach, execution of the medical team, and data recording standards may be center-specific, which limits the generalizability of the study results. Future studies should therefore include multicenter, prospective, randomized controlled trials to further investigate the efficacy of this integrated model. Such studies may also help identify subgroups of patients that are most likely to benefit from this structured intervention approach, thereby reinforcing more accurate and tailored approaches to T2DM management.

In conclusion, this retrospective cohort study indicates that a continuing care service combined with a shared outpatient management model can improve short-term metabolic control, enhance islet function, elevate the rate of disease remission, and support self-management behaviors in patients with T2DM. The findings further validate that this integrated care model provides an effective nursing strategy for long-term diabetes management and may offer a promising approach toward remission-oriented care.

• This study evaluated an integrated care model combining continuous nursing with a shared outpatient management strategy for patients with early-stage T2DM.

• Patients in the observation group achieved significantly better glycemic control, enhanced islet function, and better metabolic outcomes at 3 and 6 months compared to conventional management.

• Self-management behaviors, especially in diet, medication adherence, and blood glucose monitoring, were substantially improved in the observation group.

• The diabetes remission rate was significantly higher among patients receiving the integrated intervention, indicating that this mode may represent a promising strategy for promoting T2DM remission and enhancing long-term disease care.

The data that support the findings of this study are available from the corresponding author upon reasonable request.

CRZ and XHC designed the research study. CRZ performed the research. CRZ and XHC analyzed the data. XHC drafted this article. Both authors contributed to the important editorial changes in the manuscript. Both authors read and approved the final manuscript. Both authors have participated sufficiently in the work and agreed to be accountable for all aspects of the work.

The study was approved by the Ethics Committee of Cangnan Hospital of Wenzhou Medical University (approval number: 2024019). The Ethics Committee waived the requirement for informed consent for this was a retrospective study using only de-identified data from routine clinical practice, the research posed minimal risk to patients. The waiver complied with the institutional policies and relevant national regulations for retrospective chart review studies. All procedures adhered to the principles of the Declaration of Helsinki.

Not applicable.

This work was supported by the Science and Technology Program of Wenzhou (Grant No. Y20240820).

The authors declare no conflict of interest.