B A CASHMORE1,2, T E COOPER1,2, N M EVANGELIDIS1,2, S C PALMER3, P LOPEZ-VARGAS1,2, D J TUNNICLIFFE1,2
1School of Public Health, The University of Sydney, Sydney, Australia, 2Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia, 3Department of Medicine, University of Otago, Christchurch, New Zealand
Aim: To evaluate the benefits and harms of education programs for people with co-existing diabetes (DM) and chronic kidney disease (CKD).
Background: Interventions to improve self-management behavior require intensive education and behavioral counseling. However, whether the existing evidence is scientifically rigorous and can support recommendations for routine use of educational programs in patients with co-existing DM and CKD is still unknown.
Methods: We updated a random-effects meta-analysis of education interventions in patients with CKD and co-existing DM. The review was first published in 2011, the Cochrane Kidney and Transplant Register of Studies was searched up till May 2020. The certainty of the evidence was assessed using GRADE.
Results: Six trials (706 patients), including four new trials, were included. The addition of education to routine care compared to routine care alone improved HbA1c (%) (-0.42, 95% CI -0.52 to -0.31) (moderate certainty of the evidence). There was no difference for death (RR 0.89, 95% CI 0.32 to 2.49), serious hypoglycemia (RR 0.08, 95% CI 0.00 to 1.33), or kidney failure (RR 0.47, 95% CI 0.22 to 1.01). Education improved patients’ DM knowledge and total self-efficacy at the end of treatment. Self-management behavior improved for the following: general diet, specific diet, HBGM, checking feet, using lotion, and wearing appropriate shoes and socks.
Conclusions: Education programmes improve patient’s knowledge and self-management of DM in patients with CKD. Unsurprisingly this led to improved HbA1c in people with co-existing DM and CKD due to self-management behavior change. Further large trials are needed to examine the efficacy of education interventions on clinical outcomes in people with co-existing DM and CKD.
Brydee Cashmore is a researcher at the Centre for Kidney Research, University of Sydney, Westmead hospital, where she undertakes work for Caring for Australasians with Renal Impairment (CARI) Guideline group.