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Table 2 Characteristics of included studies

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

Study/setting N a Population Intervention (content, delivery and duration characteristics) Control Outcomesb Follow-up/dropouts/sample size analyzed Risk of bias
Blakeman et al.2014a[28]
Primary care, 24 general practices in UK
N = 101
IG—49
CG—52
ND by gender
Adult patients who had a diagnosis of stage 3 CKD.
Type of diabetes not specified.
Information and telephone-guided access to community support.
The intervention entailed provision of:
1. A kidney information guidebook.
2. A PLANS booklet and access to an interactive website with tailored access to local resources.
3. Telephone support from a peer support worker. The intervention was delivered for 4 weeks.
Patients were provided with the guidebook and website link at the end of the trial. Self-management, blood pressure control, and HRQOL Follow-up:
6 months
Dropouts: ND
Sample size analyzed: n = 101
IG: n = 49
CG: n = 52
Moderate
Barrett et al. 2011a [29]
Primary care, 5 urban centers in Canada
N = 149
IG—73
CG—76
ND by gender
40–75 years with CKD, eGFR between 25 and 60 mL/min per 1.73m2
Type 1 and 2 diabetes
Nurse-coordinated care focused on risk factor modification.
Intervention group participants had additional clinical care delivered by the study nurse and nephrologist guided by protocols aimed at achieving the prespecified targets but focused on the needs of the individual. Study visits occurred every 4 months for the duration of the study.
Patients received usual care that their health care providers felt indicated. HbA1c, blood pressure, and eGFR Follow-up:
24 months
Dropouts: ND
Sample size analyzed: n = 149
IG: n = 73
CG: n = 76
Moderate
Chan et al. 2009 [30]
Hospitals, 9 public hospitals in China
N = 205
Male:
IG—66
CG—67
Female:
IG—38
CG—34
Type 2 diabetic patients with renal insufficiency Structured care managed by a diabetes team.
A dietitian saw the intervention group after randomization. ACE inhibitor or ARB therapy was started in treatment-naive patients with monitoring of renal function at week 2, then every 4 weeks for 12 weeks and subsequently every 8–12 weeks, throughout the study period. A doctor-nurse team saw patients every 3 months and more often if indicated.
Patients were managed according to the usual clinic practice as defined by the respective hospital with no modification. Blood pressure, HbA1c, eGFR, and death Follow-up:
24 months
Dropout: n = 38
IG: n = 20
CG: n = 18
Sample size analyzed: n = 167
IG: n = 84
CG: n = 83
Low
McManus et al. 2014a [31]
Primary care practices in UK
N = 28
I—10
C—18
ND by gender
> 35 years with stroke, CHD, diabetes, or CKD and hypertension
Type of diabetes not specified.
Self-monitoring of blood pressure and individualized self-titration algorithm.
Patients in the intervention group were trained to self-monitor blood pressure in 2 or 3 sessions, each lasting approximately an hour. Following training, intervention patients went to their family physician to agree with the individualized 3-step plan to increase or add antihypertensive medications. The intervention occurred for the duration of the study.
Patients had routine blood pressure check and medication review with the participating family physician. Blood pressure Follow-up:
6 and 12 months
Dropout: ND
Sample size analyzed: n = 28
IG: n = 10
CG: n = 18
Moderate
McMurray et al. 2002 [32]
Hemodialysis or peritoneal dialysis units in USA
N = 83
Male:
IG—24
CG—21
Female:
IG—21
CG—17
ESRD on either HD or PD with a diagnosis of a type 1 or type 2 diabetes mellitus Diabetes education and care management program.
The diabetes care manager delivered self-management education, diabetes care monitoring and management, and motivational coaching to the intervention group. The renal dietitian performed initial nutritional counseling. Follow-up was performed at hemodialysis sessions or monthly for peritoneal dialysis patients.
Patients received standard diabetes care prevalent at the dialysis facility as directed by their physician. HbA1c, HRQOL, self-management behavior, and hospitalization Follow-up:
12 months
Dropout: n = 0
Sample size analyzed: n = 83
IG: n = 45
CG: n = 38
High
Scherpbier-de Haan et al. 2013a [33]
Primary care, 9 general practices in Netherlands
N = 65
Male:
IG—17
CG—16
Female:
IG—22
CG—10
> 18 years, hypertension or type 2 diabetes mellitus, and eGFR of < 60 mL/min/1.73m2 Shared care.
The nurse practitioner saw patients every 3 months for a 20-min consultation, in which blood pressure treatment was the main aim. Patients and nurse practitioners decided together which other treatment goals were to be prioritized. GPs supervised the consultation afterwards. GPs and nurse practitioners could, if necessary, consult a nephrology team in a protected digital environment.
No intervention other than routine review. Blood pressure, eGFR, and HbA1c Follow-up:
12 months
Dropout: ND
Sample size analyzed: n = 65
IG: n = 39
CG: n = 26
High
Steed et al. 2005 [34]
Outpatient clinics at two inner city hospitals in UK
N = 124
Male:
IG—44
CG—44
Female:
IG—21
CG—15
Type 2 diabetes, with renal insufficiency The University College London-Diabetes Self-management Programme (UCL-DSMP)
The intervention was a group-based program consisting of five 2.5-h sessions held weekly for 5 weeks, plus one booster session of 2.5 h held 3 months after the end of the intervention. Facilitators were diabetes specialist nurses and dieticians.
No intervention other than completion of assessments. HbA1c, self-management practices, and HRQOL Follow-up:
3 months
Dropout: n = 10
IG: n = 10
CG: n = ND
Sample size analyzed: n = 114
IG: n = 55
CG: n = 59
High
Williams et al. 2012a [35]
Outpatient clinics in Australia
N = 80
Male:
IG—22
CG—23
Female:
IG—17
CG—18
Aged > 18 years with diabetes, CKD, and systolic hypertension
Type of diabetes not specified.
Multifactorial Medication Self-Management Intervention (MESMI)
1. Self-monitoring of blood pressure.
2. An individualized medication review.
3. A 20-min digital versatile disc (DVD)
4. Fortnightly motivational interviewing follow-up telephone contact for 12 weeks to support blood pressure control and optimal medication self-management.
A renal nurse trained in motivational interviewing delivered all components of the intervention.
No intervention Blood pressure, HbA1c, eGFR Follow-up:
3, 6, and 12 months
Dropout: n = 5
IG: n = 3
CG: n = 2
Sample size analyzed: n = 75
IG: n = 36
CG: n = 39
Low
  1. aThese are participants who had diabetes and chronic kidney disease from the included studies. Additional data obtained from corresponding authors
  2. bOutcomes relevant to this systematic review; total N = 835
  3. CKD chronic kidney disease, CHD coronary heart disease, HRQOL health-related quality of life, eGFR estimated glomerular filtration rate, HbA 1c glycated hemoglobin, ESRD end-stage renal disease, HD hemodialysis, PD peritoneal dialysis, IG intervention group, CG control group, ND no data available, ACE angiotensin-converting enzyme inhibitors, ARB angiotensin II receptor blockers, PLANS patient-led assessment for network support