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    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Antón, Marta and Goering, Elizabeth M. 2015. Understanding Patients' Voices. Vol. 257, Issue. ,

    Pagels, Agneta A. Hylander, Britta and Alvarsson, Michael 2015. A MULTI-DIMENSIONAL SUPPORT PROGRAMME FOR PATIENTS WITH DIABETIC KIDNEY DISEASE. Journal of Renal Care, Vol. 41, Issue. 3, p. 187.


    Tsang, Jung Yin Blakeman, Tom Hegarty, Janet Humphreys, John and Harvey, Gill 2015. Understanding the implementation of interventions to improve the management of chronic kidney disease in primary care: a rapid realist review. Implementation Science, Vol. 11, Issue. 1,


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  • Primary Health Care Research & Development, Volume 14, Issue 3
  • July 2013, pp. 270-280

An evaluation of a self-management package for people with diabetes at risk of chronic kidney disease

  • Nicola Thomas (a1) and Rosamund Bryar (a2)
  • DOI: http://dx.doi.org/10.1017/S1463423612000588
  • Published online: 15 January 2013
Abstract
Aims and objectives

The overall purpose was to develop, test and evaluate an educational package to help people with diabetes self-manage their risk of developing chronic kidney disease (CKD), one of the main complications of diabetes.

Background

Management of people in primary care who have both CKD and diabetes can be controlled by strict blood pressure (BP) and blood sugar control and advice on lifestyle changes, such as smoking cessation. However, there is little evidence to support the assertion that self-management can slow the rate of kidney disease progression.

Design

A mixed-method longitudinal study. Development of the self-management package was informed by the findings of a case study in six GP Practices and also through interviews with 15 patients.

Methods

Testing of the self-management package was undertaken in the same six Practices, with one additional control Practice. Patients with Type 1 or Type 2 diabetes at risk of kidney disease were included. Outcomes in patients in the participating surgeries who did receive a pack (n = 116) were compared with patients in the control group (n = 60) over 6 time points.

Results

At the end of the study (time point 6), the intervention group had a mean systolic BP of 4.1 mmHg lower and mean diastolic BP of 2.7 mmHg lower than in the control group.

Conclusion

Self-management techniques such as understanding of, and subsequent concordance with, prescribed BP medication may contribute to a reduction in BP, which in turn will reduce cardiovascular risk.

Relevance to clinical practice: This study contributes to the evidence base for self-management of early kidney disease. Although the exact reason for reduced BP in the intervention group is unclear, the importance of practitioner understanding of kidney disease management and patient understanding of BP medication are likely to be the contributing factors.

Copyright
Corresponding author
Correspondence to: Dr Nicola Thomas, Renal Nurse Consulting, 10, The Horseshoe, Coulsdon CR5 2AS, Surrey, UK. Email: nicola.thomas@renalnurse.co.uk
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S. Araki , M. Haneda , D. Koya , A. Kashiwagi , T. Uzu R. Kikkawa 2008: Clinical impact of reducing microalbuminuria in patients with type 2 diabetes mellitus. Diabetes Research & Clinical Practice 82 (Suppl 1), S54S58.

R.C. Atkins 2005: The epidemiology of chronic kidney disease. Kidney International – Supplement S14S18.

C. Bebb , C. Coupland , J. Stewart , D. Kendrick , R. Madeley , N. Sturrock R. Burden 2007: Practice and patient characteristics related to blood pressure in patients with type 2 diabetes in primary care: a cross-sectional study. Family Practice 24, 547554.

R. Bilous 2008: Microvascular disease: what does the UKPDS tell us about diabetic nephropathy? Diabetic Medicine 25 (Suppl 2), 2529.

M. Campbell J. Grimshaw 1998: Cluster randomised trials: time for improvement. The implications of adopting a cluster design are still largely being ignored. British Medical Journal 317, 11711172.

I.M. Carey , C.M. Nightingale , S. DeWilde , T. Harris , P.H. Whincup D.G. Cook 2009: Blood pressure recording bias during a period when the Quality and Outcomes Framework was introduced. Journal of Human Hypertension 23, 764770.

J.L. Carter , C.R. Tomson , P.E. Stevens E.J. Lamb 2006: Does urinary tract infection cause proteinuria or microalbuminuria? A systematic review. Nephrology Dialysis Transplantation 21, 30313037.

R.B. Curtin , B.A.J. Walters , D. Schatell , P. Pennell , M. Wise K. Klicko 2008: Self-efficacy and self-management behaviors in patients with chronic kidney disease. Advances in Chronic Kidney Disease 15, 191205.

C.L. Davis , W.E. Harmon , J. Himmelfarb , T. Hostetter , N. Powe , P. Smedberg , L.A. Szczech P.S. Aronson 2008: World Kidney Day 2008: think globally, speak locally. Journal of the American Society of Nephrology 19, 413416.

DCCT Research Group.1995: Effect of intensive therapy on the development and progression of diabetic nephropathy in the Diabetes Control and Complications Trial. The Diabetes Control and Complications (DCCT) Research Group. Kidney International 47, 17031720.

S. de Lusignan , T. Chan , H. Gallagher , J. van Vlymen , N. Thomas , N. Jain , A. Tahir , M. Nation , J. Moore , F. Reid , K. Harris N. Hague 2009: Chronic kidney disease (CKD) management in southeast England: a preliminary crosssectional report from the QICKD – quality improvement in chronic kidney disease study. Primary Care Cardiovascular Journal 2, 3339.

S. Eldridge , D. Ashby , G. Feder , A. Rudnicka O. Ukoumunne 2004: Lessons for cluster randomised trials in the 21st century: a systematic review of trials in primary care. Clinical Trials 1, 8090.

M.M. Funnell , T.L. Brown , B.P. Childs , L.B. Haas , G.M. Hosey , B. Jensen , M. Maryniuk , M. Peyrot , J.D. Piette , D. Reader , L.M. Siminerio , K. Weinger M.A. Weiss 2008: National Standards for diabetes self-management education. Diabetes Care 31, S97S104.

P. Gaede , P. Vedel , N. Larsen , G.V. Jensen , H.H. Parving O. Pedersen 2003: Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. New England Journal of Medicine 348, 383393.

H.C. Gerstein 2002: Reduction of cardiovascular events and microvascular complications in diabetes with ACE inhibitor treatment: HOPE and MICRO-HOPE. Diabetes/Metabolism Research Reviews 18 (Suppl 3), S82S85.

R.E. Glasgow , L. Fisher , M. Skaff , J. Mullan D.J. Toobert 2007: Problem solving and diabetes self-management: investigation in a large, multiracial sample. Diabetes Care 30, 3337.

N. Koppiker , J. Feehally , N. Raymond , K. Abrams A. Burden 1998: Rate of decline in renal function in Indo-Asians and Whites with diabetic nephropathy. Diabetic Medicine 15, 6065.

K. Krichbaum , V. Aarestad M. Buethe 2003: Exploring the connection between self-efficacy and effective diabetes self-f management. The Diabetes Educator 29, 653662.

G. Mancia 2007: Optimal control of blood pressure in patients with diabetes reduces the incidence of macro and microvascular events. Journal of Hypertension 25 (Suppl 1), S7S12.

D.L. McLean , S.H. Simpson , F.A. McAlister R.T. Tsuyuki 2006: Treatment and blood pressure control in 47 964 people with diabetes and hypertension: a systematic review of observational studies. Canadian Journal of Cardiology 22, 855860.

J. Mourad S. Le Jeune 2008: Blood pressure control, risk factors and cardiovascular prognosis in patients with diabetes: 30 years of progress. Journal of Hypertension – Supplement 26, S7S13.

J.P. New , R.J. Middleton , B. Klebe , C.K. Farmer , S. de Lusignan , P.E. Stevens , D.J. O'Donoghue C.K.T. Farmer 2007: Assessing the prevalence, monitoring and management of chronic kidney disease in patients with diabetes compared with those without diabetes in general practice. Diabetic Medicine 24, 364369.

M.A. Sprague , J.A. Shultz L.J. Branen 2006: Understanding patient experiences with goal setting for diabetes self-management after diabetes education. Family & Community Health 29, 245255.

P.E. Stevens , D. O'Donoghue , S. de Lusignan , J. Van Vlymen , B. Klebe , R. Middleton , N. Hague , J. New C.K. Farmer 2007: Chronic kidney disease management in the United Kingdom: NEOERICA project results. Kidney International 72, 9299.

N. Thomas , R. Bryar D. Makanjuola 2008: Development of a self-management package for people with diabetes at risk of chronic kidney disease (CKD). Journal of Renal Care 34, 151158.

A. Warsi , P.S. Wang , M.P. LaValley , J. Avorn , D.H. Solomon , A. Warsi , P.S. Wang , M.P. LaValley , J. Avorn D.H. Solomon 2004: Self-management education programs in chronic disease: a systematic review and methodological critique of the literature. Archives of Internal Medicine 164, 16411649.

J. Bland 2004: Cluster randomised trials in the medical literature: two bibliometric surveys. BMC Medical Research Methodology 4, 21.

M. Tahir , H. Gallagher , N. Thomas , K. Harris S. de Lusignan 2011: Confidence and quality in managing CKD compared with other cardiovascular disease: a linked study of questionnaire and routine primary care data. BMC Family Practice 12, 83.

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Primary Health Care Research & Development
  • ISSN: 1463-4236
  • EISSN: 1477-1128
  • URL: /core/journals/primary-health-care-research-and-development
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