Effectiveness of self-management support interventions for people with comorbid diabetes and chronic kidney disease: a systematic review and meta-analysis

Edward Zimbudzi, Clement Lo, Marie L Misso, Sanjeeva Ranasinha, Peter G Kerr, Helena J Teede, Sophia Zoungas, Edward Zimbudzi, Clement Lo, Marie L Misso, Sanjeeva Ranasinha, Peter G Kerr, Helena J Teede, Sophia Zoungas

Abstract

Background: Self-management support interventions may potentially delay kidney function decline and associated complications in patients with comorbid diabetes and chronic kidney disease. However, the effectiveness of these interventions remains unclear. We investigated the effectiveness of current self-management support interventions and their specific components and elements in improving patient outcomes.

Methods: Electronic databases were systematically searched from January 1, 1994, to December 19, 2017. Eligible studies were randomized controlled trials on self-management support interventions for adults with comorbid diabetes and chronic kidney disease. Primary outcomes were systolic blood pressure, diastolic blood pressure, estimated glomerular filtration rate, and glycated hemoglobin. Secondary outcomes included self-management activity, health service utilization, health-related quality of life, medication adherence, and death.

Results: Of the 48 trials identified, eight studies (835 patients) were eligible. There was moderate-quality evidence that self-management support interventions improved self-management activity (standard mean difference 0.56, 95% CI 0.15 to 0.97, p < 0.007) compared to usual care. There was low-quality evidence that self-management support interventions reduced systolic blood pressure (mean difference - 4.26 mmHg, 95% CI - 7.81 to - 0.70, p = 0.02) and glycated hemoglobin (mean difference - 0.5%, 95% CI - 0.8 to - 0.1, p = 0.01) compared to usual care.

Conclusions: Self-management support interventions may improve self-care activities, systolic blood pressure, and glycated hemoglobin in patients with comorbid diabetes and chronic kidney disease. It was not possible to determine which self-management components and elements were more effective, but interventions that utilized provider reminders, patient education, and goal setting were associated with improved outcomes. More evidence from high-quality studies is required to support future self-management programs.

Systematic review registration: PROSPERO CRD42015017316 .

Keywords: Chronic kidney disease; Diabetes; Interventions; Meta-analyses; Self-management; Systematic review.

Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram showing how studies were screened [13]
Fig. 2
Fig. 2
Meta-analyses showing effect of the different intervention components on a systolic blood pressure, b diastolic blood pressure, c estimated glomerular filtration rate, d glycated hemoglobin (%), e self-management activity, and f health-related quality of life. Intervention components with one trial are not based on meta-analysis (individual trial result is presented)
Fig. 3
Fig. 3
Forest plots displaying the effectiveness of self-management support interventions in improving outcomes for patients with diabetes and chronic kidney disease: a systolic blood pressure, b diastolic blood pressure, c estimated glomerular filtration rate, d hemoglobin A1c, e self-management activity, and f health-related quality of life. The x-axis represents mean differences or standard mean differences. The 95% confidence intervals (CI) for individual studies are represented by a horizontal line and by a diamond for pooled effect. SD standard deviation, IV inverse variance

References

    1. Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract. 2014;103(2):137–149. doi: 10.1016/j.diabres.2013.11.002.
    1. Ogurtsova K, da Rocha Fernandes JD, Huang Y, et al. IDF diabetes atlas: global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract. 2017;128:40–50. doi: 10.1016/j.diabres.2017.03.024.
    1. Chowdhury TA, Shaho S, Moolla A. Complications of diabetes: progress, but significant challenges ahead. Ann Transl Med. 2014;2(12):120.
    1. Mills KT, Xu Y, Zhang W, et al. A systematic analysis of worldwide population-based data on the global burden of chronic kidney disease in 2010. Kidney Int. 2015;88(5):950–957. doi: 10.1038/ki.2015.230.
    1. Schernthaner G. Kidney disease in diabetology. Nephrol Dialysis Transplantation. 2007;22(3):703–707. doi: 10.1093/ndt/gfm061.
    1. Tuttle KR, Bakris GL, Bilous RW, et al. Diabetic kidney disease: a report from an ADA consensus conference. Am J Kid Dis. 2014;64(4):510–533. doi: 10.1053/j.ajkd.2014.08.001.
    1. Palsson R, Patel UD. Cardiovascular complications of diabetic kidney disease. Adv Chronic Kidney Dis. 2014;21(3):273–280. doi: 10.1053/j.ackd.2014.03.003.
    1. Zimbudzi E, Lo C, Ranasinha S, et al. Predictors of health-related quality of life in patients with co-morbid diabetes and chronic kidney disease. PLoS One. 2016;11(12):e0168491. doi: 10.1371/journal.pone.0168491.
    1. Ko GT, Yeung CY, Leung WY, et al. Cost implication of team-based structured versus usual care for type 2 diabetic patients with chronic renal disease. Hong Kong Med J. 2011;17(6):9–12.
    1. Welch JL, Johnson M, Zimmerman L, Russell CL, Perkins SM, Decker BS. Self-management interventions in stages 1 to 4 chronic kidney disease: an integrative review. West J Nurs Res. 2015;37(5):652–678. doi: 10.1177/0193945914551007.
    1. Griva K, Mooppil N, Khoo E, Lee VYW, Kang AWC, Newman SP. Improving outcomes in patients with coexisting multimorbid conditions—the development and evaluation of the combined diabetes and renal control trial (C-DIRECT): study protocol. BMJ Open. 2015;5(2):e007253. doi: 10.1136/bmjopen-2014-007253.
    1. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration; 2011. Available from .
    1. Moher DL, Tetzlaff A, Altman J, G D. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi: 10.1371/journal.pmed.1000097.
    1. Zimbudzi E LC, Misso M, Ranhasinha S, Zoungas S. Effectiveness of management models for facilitating self-management and patient outcomes in people with diabetes and chronic kidney disease PROSPERO 2015:CRD42015017316; [Available from: . Accessed 10 Mar 2017.
    1. Zimbudzi E, Lo C, Misso M, Ranasinha S, Zoungas S. Effectiveness of management models for facilitating self-management and patient outcomes in adults with diabetes and chronic kidney disease. Syst Rev. 2015;4:81. doi: 10.1186/s13643-015-0072-9.
    1. The National Kidney Foundation (NKF). Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2-1):S1–266.
    1. Adams K, Greiner AC, Corrigan JM. Report of a summit. The 1st annual crossing the quality chasm summit—a focus on communities. Washington, DC: National Academies Press; 2004.
    1. Monash Centre for Health Research and Implementation (MCHRI). Evidence Synthesis Program templates for critical appraisal and risk of bias (adapted from Critical Appraisal Templates, Centre for Clinical Effectiveness, Southern Health, Melbourne, 2010). Melbourne: MCHRI-Monash University and Monash Health; 2013.
    1. Guyatt GH, Oxman AD, Schünemann HJ, Tugwell P, Knottnerus A. GRADE guidelines: a new series of articles in the journal of clinical epidemiology. J Clin Epidemiol. 2011;64(4):380–382. doi: 10.1016/j.jclinepi.2010.09.011.
    1. Viechtbauer W. Accounting for heterogeneity via random-effects models and moderator analyses in meta-analysis. Z Psychol. 2007;215(2):104–121. doi: 10.1027/0044-3409.215.2.104.
    1. Strand H, Parker D. Effects of multidisciplinary models of care for adult pre-dialysis patients with chronic kidney disease: a systematic review. Int J Evid Based Healthc. 2012;10(1):53–59. doi: 10.1111/j.1744-1609.2012.00253.x.
    1. McDonald HP, Garg AX, Haynes RB. Interventions to enhance patient adherence to medication prescriptions: scientific review. JAMA. 2002;288(22):2868–2879. doi: 10.1001/jama.288.22.2868.
    1. Santschi V, Chiolero A, Burnand B, Colosimo AL, Paradis G. Impact of pharmacist care in the management of cardiovascular disease risk factors: a systematic review and meta-analysis of randomized trials. Arch Intern Med. 2011;171(16):1441–1453. doi: 10.1001/archinternmed.2011.399.
    1. Roshanov PS, Misra S, Gerstein HC, et al. Computerized clinical decision support systems for chronic disease management: a decision-maker-researcher partnership systematic review. Implement Sci. 2011;6:92. doi: 10.1186/1748-5908-6-92.
    1. Bowles KH, Baugh AC. Applying research evidence to optimize telehomecare. J Cardiovasc Nurs. 2007;22(1):5–15. doi: 10.1097/00005082-200701000-00002.
    1. Sintchenko V, Magrabi F, Tipper S. Are we measuring the right end-points? Variables that affect the impact of computerised decision support on patient outcomes: a systematic review. Med Inform Internet Med. 2007;32(3):225–240. doi: 10.1080/14639230701447701.
    1. Li T, Wu HM, Wang F, et al. Education programmes for people with diabetic kidney disease. Cochrane Database Syst Rev. 2011;(6):Cd007374.
    1. Blakeman T, Blickem C, Kennedy A, et al. Effect of information and telephone-guided access to community support for people with chronic kidney disease: randomised controlled trial. PLoS One. 2014;9(10):e109135. doi: 10.1371/journal.pone.0109135.
    1. Barrett BJ, Garg AX, Goeree R, Levin A, Molzahn A, Rigatto C, Singer J, Soltys G, Soroka S, Ayers D, Parfrey PS. A nurse-coordinated model of care versus usual care for stage 3/4 chronic kidney disease in the community: a randomized controlled trial. Clin J Am Soc Nephrol. 2011;6(6):1241–1247. doi: 10.2215/CJN.07160810.
    1. Chan JC, So WY, Yeung CY, et al. Effects of structured versus usual care on renal endpoint in type 2 diabetes: the SURE study: a randomized multicenter translational study. Diabetes Care. 2009;32(6):977–982. doi: 10.2337/dc08-1908.
    1. McManus RJ, Mant J, Haque MS, et al. Effect of self-monitoring and medication self-titration on systolic blood pressure in hypertensive patients at high risk of cardiovascular disease: the TASMIN-SR randomized clinical trial. JAMA. 2014;312(8):799–808. doi: 10.1001/jama.2014.10057.
    1. McMurray SD, Johnson G, Davis S, McDougall K. Diabetes education and care management significantly improve patient outcomes in the dialysis unit. Am J Kidney Dis. 2002;40(3):566–575. doi: 10.1053/ajkd.2002.34915.
    1. Scherpbier-de Haan ND, Vervoort GM, van Weel C, et al. Effect of shared care on blood pressure in patients with chronic kidney disease: a cluster randomised controlled trial. Br J Gen Pract. 2013;63(617):e798–e806. doi: 10.3399/bjgp13X675386.
    1. Steed L, Lankester J, Barnard M, Earle K, Hurel S, Newman S. Evaluation of the UCL diabetes self-management programme (UCL-DSMP): a randomized controlled trial. J Health Psychol. 2005;10(2):261–276. doi: 10.1177/1359105305049775.
    1. Williams A, Manias E, Walker R, Gorelik A. A multifactorial intervention to improve blood pressure control in co-existing diabetes and kidney disease: a feasibility randomized controlled trial. J Adv Nurs. 2012;68(11):2515–2525. doi: 10.1111/j.1365-2648.2012.05950.x.
    1. Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q. 1996;74(4):511–544. doi: 10.2307/3350391.
    1. Lorig KR, Sobel DS, Stewart AL, et al. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Med Care. 1999;37(1):5–14. doi: 10.1097/00005650-199901000-00003.
    1. Rogers A, Kennedy A, Bower P, et al. The United Kingdom Expert Patients Programme: results and implications from a national evaluation. Med J Aust. 2008;189(10):S21–S24.
    1. Battersby M, Harvey P, Mills PD, et al. SA HealthPlus: a controlled trial of a statewide application of a generic model of chronic illness care. Milbank Q. 2007;85(1):37–67. doi: 10.1111/j.1468-0009.2007.00476.x.
    1. Bosworth HB, Olsen MK, Grubber JM, et al. Two self-management interventions to improve hypertension control: a randomized trial. Ann Intern Med. 2009;151(10):687–695. doi: 10.7326/0000605-200911170-00148.
    1. Chrvala CA, Sherr D, Lipman RD. Diabetes self-management education for adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic control. Patient Educ Couns. 2016;99(6):926–943. doi: 10.1016/j.pec.2015.11.003.
    1. DeWalt DA, Davis TC, Wallace AS, et al. Goal setting in diabetes self-management: taking the baby steps to success. Patient Educ Couns. 2009;77(2):218–223. doi: 10.1016/j.pec.2009.03.012.
    1. Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care. 2003;41(5):582–592.
    1. Cuijpers P, Turner EH, Koole SL, van Dijke A, Smit F. What is the threshold for a clinically relevant effect? The case of major depressive disorders. Depress Anxiety. 2014;31(5):374–378. doi: 10.1002/da.22249.
    1. Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract. 1998;1(1):2–4.
    1. MacLean CD, Littenberg B, Gagnon M, Reardon M, Turner PD, Jordan C. The Vermont Diabetes Information System (VDIS): study design and subject recruitment for a cluster randomized trial of a decision support system in a regional sample of primary care practices. Clinical trials (London, England) 2004;1(6):532–544. doi: 10.1191/1740774504cn051oa.
    1. Piatt GA, Orchard TJ, Emerson S, et al. Translating the chronic care model into the community: results from a randomized controlled trial of a multifaceted diabetes care intervention. Diabetes Care. 2006;29(4):811–817. doi: 10.2337/diacare.29.04.06.dc05-1785.
    1. Smith SA, Shah ND, Bryant SC, et al. Chronic care model and shared care in diabetes: randomized trial of an electronic decision support system. Mayo Clin Proc. 2008;83(7):747–757. doi: 10.4065/83.7.747.
    1. Siminerio LM, Piatt G, Zgibor JC. Implementing the chronic care model for improvements in diabetes care and education in a rural primary care practice. Diabetes Educ. 2005;31(2):225–234. doi: 10.1177/0145721705275325.
    1. Chen YR, Yang Y, Wang SC, et al. Effectiveness of multidisciplinary care for chronic kidney disease in Taiwan: a 3-year prospective cohort study. Nephrol Dial Transplant. 2013;28(3):671–682. doi: 10.1093/ndt/gfs469.
    1. Kidney Disease Improving Global Outcomes (KDIGO CKD) Work Group. “Chapter 5: referral to specialists and models of care” in KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease Kidney Int Suppl. 2013;3(1):112–119.
    1. Friedberg JP, Lipsitz SR, Natarajan S. Challenges and recommendations for blinding in behavioral interventions illustrated using a case study of a behavioral intervention to lower blood pressure. Patient Educ Couns. 2010;78(1):5–11. doi: 10.1016/j.pec.2009.04.009.
    1. IntHout J, Ioannidis JP, Borm GF, Goeman JJ. Small studies are more heterogeneous than large ones: a meta-meta-analysis. J Clin Epidemiol. 2015;68(8):860–869. doi: 10.1016/j.jclinepi.2015.03.017.

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