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Efficacy of a disease management program focused on acquisition of self-management skills in pre-dialysis patients with diabetic nephropathy: 24 months follow-up

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Abstract

Purpose

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.

Conclusion

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.

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Acknowledgments

We would like to express our deepest gratitude to the Kure City medical insurance staff who provided the field for this study. We are also indebted to the disease management nurses for their support.

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical standards

Approval was obtained from the ethics committees of Hiroshima University Hospital and the participating medical institutions. All subjects gave written consent to participation and the study was performed according to the Declaration of Helsinki.

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Authors and Affiliations

  1. Division of Nursing Science, Institute of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3 Minami-Ku, Hiroshima, 734-8553, Japan

    Kana Kazawa & Michiko Moriyama

  2. Division of Nursing Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3 Minami-Ku, Hiroshima, 734-8553, Japan

    Yae Takeshita

  3. Hiroshima Kidney Organization, Yanoshinmachi 2-2-19 Aki-Ku, Hiroshima, 736-0084, Japan

    Noriaki Yorioka

Authors
  1. Kana Kazawa
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  2. Yae Takeshita
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  3. Noriaki Yorioka
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  4. Michiko Moriyama
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Corresponding author

Correspondence to Kana Kazawa.

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Kazawa, K., Takeshita, Y., Yorioka, N. et al. Efficacy of a disease management program focused on acquisition of self-management skills in pre-dialysis patients with diabetic nephropathy: 24 months follow-up. J Nephrol 28, 329–338 (2015). https://doi.org/10.1007/s40620-014-0144-2

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  • DOI: https://doi.org/10.1007/s40620-014-0144-2

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