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

Background: Self-management support interventions may potentially delay kidney function decline and associated complications in patients with comorbid diabetes and chronic kidney disease. However, the effectiveness of these interventions remains unclear. We investigated the effectiveness of current self-management support interventions and their specific components and elements in improving patient outcomes. Methods: Electronic databases were systematically searched from January 1, 1994, to December 19, 2017. Eligible studies were randomized controlled trials on self-management support interventions for adults with comorbid diabetes and chronic kidney disease. Primary outcomes were systolic blood pressure, diastolic blood pressure, estimated glomerular filtration rate, and glycated hemoglobin. Secondary outcomes included self-management activity, health service utilization, health-related quality of life, medication adherence, and death. Results: Of the 48 trials identified, eight studies (835 patients) were eligible. There was moderate-quality evidence that self-management support interventions improved self-management activity (standard mean difference 0.56, 95% CI 0.15 to 0.97, p<0.007) compared to usual care. There was low-quality evidence that self-management support interventions reduced systolic blood pressure (mean difference -4.26mmHg, 95% CI -7.81 to -0.70, p=0.02) and glycated hemoglobin (mean difference -0.5%, 95% CI -0.8 to -0.1, p=0.01) compared to usual care. Conclusions: Self-management support interventions may improve self-care activities, systolic blood pressure, and glycated hemoglobin in patients with comorbid diabetes and chronic kidney disease. It was not possible to determine which self-management components and elements were more effective, but interventions that utilized provider reminders, patient education, and goal setting were associated with improved outcomes. More evidence from high-quality studies is required to support future self-management programs. Systematic review registration: PROSPERO CRD42015017316.