The Diabetes Camp Paradox: An Evidence Gap Map of 279 Publications and the Anatomy of Known Unknowns.

aimTo map the diabetes camp literature across five epistemic layers and to construct an operationalised evidence gap matrix identifying structural knowledge gaps relevant to nursing practice, education and policy.

designScoping review reported in accordance with the PRISMA-ScR guideline. DATA SOURCES: Web of Science Core Collection, Scopus, OVID/MEDLINE and PubMed, searched on 19 June 2026 without date restriction (results spanned 1931-2026). REVIEW

methodsA title-field search ('diabet*' AND 'camp') across four databases yielded 1591 records that, after homonym screening, cross-database deduplication, publication-type and English-language filtering, and a supplementary PubMed search, produced a deduplicated evidence map of 279 records. Two reviewers independently double-coded the analytic set; inter-rater reliability was almost perfect (Cohen's kappa 0.955 for outcome direction and 0.960 for study design). The 199 records carrying an extractable abstract formed the analytic set and were coded across four dimensions (outcome direction, study design, follow-up duration and thematic area); proportions are reported with Wilson 95% confidence intervals.

resultsOf the 199 analytic records, 104 (52.3%) reported a measured directional outcome; of these, 90.4% documented benefit in at least one dimension, but 32.7% contained mixed or non-significant sub-outcomes and only 57.7% were entirely positive. Only 12 records (6.0%) reported follow-up of 6 months or longer, and post-camp glycaemic deterioration was documented consistently across the longitudinal evidence. The evidence base was predominantly descriptive (51.8%), with only 6.5% employing a controlled experimental design; just 9 records (4.5%) combined an analytic-or-stronger design, follow-up of at least 6 months and a measured outcome. No study provided cost-effectiveness analysis, per-camp unit cost data or comparative evidence on physical versus virtual delivery models.

conclusionThe diabetes camp literature is structurally incomplete: benefit is selective, temporally fragile, socially inequitable and entirely uncosted. Resolving this paradox requires temporal expansion (12-month follow-up), dimensional expansion (multidimensional outcome packages) and structural expansion (cost-effectiveness analysis and delivery-model comparison). IMPACT: This review identifies actionable evidence gaps for paediatric, public health and school nurses involved in camp-based diabetes self-management education, informing nurse-led longitudinal follow-up, equitable access strategies and economic accountability in nursing-delivered camp interventions. PATIENT OR PUBLIC CONTRIBUTION: The first author is fathering a child with autism, and he is focusing on rationalistic design of health services during his career. The co-author is the head of a nonprofit association established in 2010, the mission of which is advocating, supporting, educating and motivating children with diabetes and their families. Its board is made of three mothers of children with diabetes, one young adult with diabetes, one social worker who has been part of the paediatric diabetes team for 20 years and one diabetes specialist nurse. This association conducts numerous diabetes camps every year and is pioneering camp activities in the country by far. A big part of these camps is conducted in limited resource settings, which was reviewed in an article published in Diabetes Voice, the official journal of the International Diabetes Federation. The article we submit now is motivated by these activities.