title: Efficacy of a disease management program focused on acquisition of self-management skills in pre-dialysis patients with diabetic nephropathy: 24 months follow-up.
abstract: OBJECTIVE
  We previously performed a preliminary 6-month controlled trial to examine the effect of a disease management education program on prolongation of the time to renal replacement therapy (RRT) and/or avoidance of RRT for patients with diabetic nephropathy. However, its duration was too short to follow the changes of renal function, so we performed the present study for 24 months.
  
  
  METHODS
  This was a two-group comparative study. The intervention group received self-management education from disease management nurses and was supported by the nurses in cooperation with their primary physicians for 12 months. Then this group was followed for a further 12 months. The control group received standard care and was followed for 24 months.
  
  
  RESULTS
  Of the 31 subjects enrolled in each group, 26 subjects in the intervention group and 27 subjects in the control group were analyzed after excluding drop-outs. During the study period, 0 and 2 subjects in the intervention and the control group started RRT, respectively. In the intervention group, renal function was maintained, while significant worsening was observed in the control group. Hemoglobin A1c (HbA1c) improved in the intervention group, but became significantly worse in the control group. In the intervention group, all process indicators of behavior modification increased significantly after intervention.
  
  
  CONCLUSIONS
  A well-designed disease management program might be useful for maintaining renal function and improving HbA1c in patients with diabetic nephropathy. It is considered that modification of patient behavior contributed to these results.
authors.affiliation: Division of Nursing Science, Institute of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3 Minami-Ku, Hiroshima, 734-8553, Japan, kanak1016@gmail.com.
authors.forename: Kana
authors.initials: K
authors.lastname: Kazawa
authors.forename: Yae
authors.initials: Y
authors.lastname: Takeshita
authors.forename: Noriaki
authors.initials: N
authors.lastname: Yorioka
authors.forename: Michiko
authors.initials: M
authors.lastname: Moriyama
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D003928:Diabetic Nephropathies / Q000097:blood / Q000175:diagnosis / Q000451:nursing* / Q000503:physiopathology / Q000523:psychology; D018450:Disease Progression; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007564:Japan; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D017582:Renal Replacement Therapy; D012648:Self Care / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human