Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

Effectiveness of self-management interventions for people with diabetes and CKD -a systematic review (#294)

EDWARD ZIMBUDZI 1 2 , Clement Lo 1 3 , Marie Misso 1 , Sanjeeva Ranasinha 1 , Peter Kerr 2 4 , Helena Teede 1 3 , Sophia Zoungas 1 3 5 , Clement Lo 1 6
  1. Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
  2. Department of Nephrology, Monash Health, Melbourne, Victoria, Australia
  3. Diabetes and Vascular Medicine Unit, Monash Health , Melbourne, Victoria, Australia
  4. Monash University, Melbourne, Victoria, Australia
  5. The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia
  6. Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia

Abstract

Background

Self-management interventions may potentially delay kidney function decline and associated complications in patients with diabetes and chronic kidney disease (CKD). However, the effectiveness of these interventions remains unclear.

Objectives

To investigate the effectiveness of current self-management interventions and their specific components in improving patient outcomes.

Method

Medline (including Medline in-process), Excerpta medica (EMBASE), Cumulative Index to Nursing and Allied Health (CINAHL) and all Evidence-based medicine (EBM) databases were systematically searched for randomised controlled studies comparing self-management interventions with usual care in patients with diabetes and CKD. Two reviewers independently assessed articles for eligibility and methodological quality using GRADE. Data was tabulated and narratively synthesised and meta-analyses were performed for outcomes with sufficient homogenous data.

Results

Of the 45 trials identified, 8 studies (835 patients) with a high risk of bias were eligible. There was moderate quality evidence that self-management interventions improved self-care behaviour (SMD 0.54, 95% CI 0.29 to 0.79, P < 0.0001) compared to usual care. There was low quality evidence that self-management interventions reduced systolic blood pressure (MD -4.26 mmHg, 95% CI -7.81 to -0.70, P=0.02) and HbA1c (MD -0.46%, 95% CI -0.83 to -0.09, P = 0.01) compared to usual care. Treatment effects were greater for interventions that included provider reminders, patient education and goal setting.

Conclusions

Self-management interventions improve self-care behaviours and may reduce systolic blood pressure and HbA1c in patients with diabetes and CKD. Self-management components associated with improved outcomes included provider reminders, patient education and goal setting provided in multidisciplinary settings. More evidence from high quality studies is required to support these findings.