A MULTI-DIMENSIONAL SUPPORT PROGRAMME FOR PATIENTS WITH DIABETIC KIDNEY DISEASE.
BACKGROUND
Diabetes is currently the most common cause of kidney disease among patients receiving renal replacement therapy. Pedagogical interventions to promote self-management and secondary prevention have been shown to be effective in delaying disease progression.


OBJECTIVE
A non-randomised, quasi-experimental design ('uncontrolled before and after') to evaluate the effects of a group-based, multidisciplinary and multidimensional support programme in patients with diabetic kidney disease. The programme comprised 1) Disease-related knowledge, 2) Skills training and increased self-care agency 3) A motivational approach, with group discussions, participant questions and narratives, setting and follow-up of individual health goals.


METHODS
Fifty-eight patients with diabetic kidney disease.


METHODS
Glycated haemoglobin (HbA1c), urine albumin/creatinine ratio, blood pressure, body mass index, waist, physical activity and participant experiences from the programme.


RESULTS
The evaluation indicated positive effects on HbA1c, albuminuria and physical activity at follow-up after four months. The proportion of patients achieving blood pressure targets increased. The participants reported improved understanding of their health condition and treatment regime.


CONCLUSIONS
The multidimensional support programme, addressing health-promoting factors and self-management in small patient groups, has a potential to effectively reduce HbA1c and may have some beneficial effects which contribute to health promotion in patients with diabetic kidney disease. This mode of a multidimensional support programme should continue to develop, with longer term follow-up and further evaluations with appropriate research designs.
Department of Nephrology, Karolinska University Hospital, Stockholm, Sweden.
Agneta A
AA
Pagels
Karolinska Institutet, Department of Medicine & Karolinska University Hospital, Department of Nephrology, Stockholm, Sweden.
Britta
B
Hylander
Karolinska Institutet, Department of Medicine & Karolinska University Hospital, Department of Nephrology, Stockholm, Sweden.
Michael
M
Alvarsson
D000368:Aged; D000419:Albuminuria / Q000652:urine; D001794:Blood Pressure; D015992:Body Mass Index; D003404:Creatinine / Q000652:urine; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000628:therapy; D003928:Diabetic Nephropathies / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000032:analysis; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D065228:Non-Randomized Controlled Trials as Topic; D010353:Patient Education as Topic / Q000379:methods*; D012648:Self Care
D003404:Creatinine; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
Chronic kidney disease; Diabetes; Patient education; Self-management