title: Self-management in patients with diabetes and chronic kidney disease is associated with incremental benefit in HRQOL.
abstract: OBJECTIVE
  There is insufficient and inconsistent data regarding the association between diabetes self-management, the process of facilitating the knowledge, skill, and ability necessary for diabetes self-care, and health-related quality of life (HRQOL) in people with diabetes and moderate to severe chronic kidney disease (CKD).
  
  
  METHODS
  In a cross sectional study, participation in diabetes self-management assessed by the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire and HRQOL was examined in 308 patients with diabetes and CKD (stages 3 to 5) recruited from outpatient diabetes and renal clinics of 4 public tertiary hospitals. Associations were examined by Pearson correlation coefficients and hierarchical multiple regression after controlling for potential confounders. An examination of trend across the levels of patient participation in self-management was assessed using a non-parametric test for trend.
  
  
  RESULTS
  The median age and interquartile range (IQR) of patients were 68 and 14.8years, respectively with 59% of the population being over 65years old and 69.5% male. The median durations of diabetes and CKD were 18years (IQR-17) and 5years (IQR-8) respectively. General diet, exercise and medication taking were positively associated with at least one HRQOL subscale (all p<0.05) but diabetes specific diet, blood sugar testing and foot checking were not. As levels of participation in self-management activities increased there was a graded increase in mean HRQOL scores across all subscales (p for trend <0.05).
  
  
  CONCLUSIONS
  In people with diabetes and moderate to severe CKD, participation in diabetes self-management activities, particularly those focused on general diet, exercise and medication taking, was associated with higher HRQOL.
authors.affiliation: Department of Nephrology, Monash Health, Melbourne, Australia; Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Edward
authors.initials: E
authors.lastname: Zimbudzi
authors.affiliation: Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia.
authors.forename: Clement
authors.initials: C
authors.lastname: Lo
authors.affiliation: Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Sanjeeva
authors.initials: S
authors.lastname: Ranasinha
authors.affiliation: Department of Nephrology, Monash Health, Melbourne, Australia.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Kerr
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia; Department of General Practice, Sydney Medical School Westmead, Sydney, Australia.
authors.forename: Timothy
authors.initials: T
authors.lastname: Usherwood
authors.affiliation: Menzies School of Health Research, Darwin, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: Cass
authors.affiliation: Department of Endocrinology, University of Sydney, Sydney, Australia.
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Fulcher
authors.affiliation: Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia; The George Institute for Global Health, University of Sydney, Sydney, Australia. Electronic address: sophia.zoungas@monash.edu.
authors.forename: Sophia
authors.initials: S
authors.lastname: Zoungas
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy / Q000009:adverse effects; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000628:therapy*; D003928:Diabetic Nephropathies / Q000503:physiopathology / Q000628:therapy*; D018450:Disease Progression; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D010044:Outpatient Clinics, Hospital; D010349:Patient Compliance; D011446:Prospective Studies; D011788:Quality of Life; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D057566:Self Report; D000073278:Self-Management; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D014739:Victoria
keywords: Chronic kidney disease; Diabetes; Health-related quality of life; Self-care; Self-management behavior