Table 2 Characteristics of included studies
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 |