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Table 4 Summary of findings for the main comparison

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

Self-management compared with control for participants with diabetes and chronic kidney disease
Patient or population: patients with diabetes and chronic kidney disease
Settings: community, primary care, hospital outpatient
Intervention: self-management
Comparison: standard care
Outcomes Impact Relative effect estimate (95% CI) No. of studies (participants) Quality of evidence (GRADE)a
Systolic blood pressure
Follow-up: 6 to 24 months
[28,29,30,31, 33, 35]
SBP MDs ranged from − 8.90 to 3.60 mmHg.One study* [28] was excluded from the meta-analysis due to insufficient data. MD − 4.26 (− 7.81, − 0.71) 6 (577) Low1
Diastolic blood pressure
Follow-up: 12 to 24 months
[30, 31, 33, 35]
DBP MDs − 7.50 to 2.30 mmHg MD − 2.70 (− 6.19, 0.78) 4 (336) Low1
eGFR
Follow-up: 12 to 24 months
[29, 30, 33, 35]
Estimated GFR MDs ranged from -2.60 to 3.50 mL/min/1.73 m2. One study* [29] was excluded from the meta-analysis due to insufficient data. MD 0.59 (− 4.12, 5.29) 4 (499) Very low1, 2, 3
HbA1c
Follow-up: 3–24 months
[29, 30, 32,33,34,35]
HbA1c MDs ranged from − 0.90 to 0.30%. MD − 0.46% (− 0.83, − 0.09) 6 (595) Low1, 3
Adherence to medications
Follow-up: 12 months
[35]
One study [35] identified no difference in medication adherence between the control and intervention groups using the Morisky scale. Not estimable 1 (80) Moderate4
Self-management activity
Follow-up: 3–12 months
[28, 32, 34]
The self-management SMDs for the three studies ranged from 0.31 to 0.99. SMD 0.56 (0.15, 0.97) 3 (308) Moderate5
Health service utilization
Follow-up: 6–24 months
[28, 30, 32]
Two studies [28, 30] showed no differences in hospitalization between the intervention and control groups and one study [32] reported that the study group had lower hospitalization rates. Not estimable 3 (389) Low1
Health-related quality of life
Follow-up: 3–12 months
[28, 32,33,34]
Two studies [28, 33] showed no difference in quality of life between the intervention and control groups, and in the other two studies [32, 34], the intervention group showed a statistically significant improvement in the quality of life assessment. SMD − 0.03 (− 0.36, 0.31) 4 (373) Moderate1
Death
Follow-up: 12 to 24 months
[30,31,32]
The three studies showed no differences in mortality between the intervention and control groups. Not estimable 3 (354) Very low1, 6
  1. High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate
  2. SBP systolic blood pressure, MDs mean differences, CI confidence interval, DBP diastolic blood pressure, eGFR estimated glomerular filtration rate, HbA 1c glycated hemoglobin, SMD standard mean difference
  3. aStudies were excluded from the meta-analysis due to non-availability of data. GRADE Working Group grades of evidence
  4. 1The majority of the studies were not blinded to patients or outcome assessors and they did not report allocation concealment. The quality of evidence was downgraded by 2
  5. 2There was a considerable degree of inconsistency with several studies reporting effects in opposite directions. The quality of evidence was downgraded by 1
  6. 3One study reported on eGFR, but there was no data
  7. 4Relative estimate was not estimable. There were some discrepancies in responses as participants reported that they had no problem remembering to take their medications but at the same time they forgot to take their medications and vice versa. This study had allocation concealment and was blinded to investigators and outcome assessors. We did not downgrade based on limitations
  8. 5Heterogeneity was moderate (I2 = 63%). The 95% confidence intervals for some individual studies were narrower
  9. 6Death was reported by three studies (for the subgroup of patients with diabetes and chronic kidney disease), but the relative effect was not estimable