Diabetic Kidney Disease: Can a Multidisciplinary Program Improve Quality of Life, Self-Care Adherence?
A nurse-led, multidisciplinary self-care management program (MSMP) improves quality of life and adherence to self-care activities among patients with diabetic kidney disease (DKD) compared with usual care, according to a recent study.
Findings were presented by Dr Nancy Helou on August 29, 2017, at the 2nd Annual Kidney Congress in Philadelphia, Pennsylvania.
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DKD is associated with high morbidity and mortality worldwide. Patients with DKD are typically expected to manage their daily self-care routines. However, poor control and complications related to DKD continue to occur, with patient non-adherence to treatment regimens likely being a major cause. Although existing evidence has demonstrated that multidisciplinary management of self-care can improve outcomes among patients with DKD, less is known about the impact of MSMP on quality of life, self-care, adherence to antihypertensive therapy, glycemic control, and renal function among this patient population.
To explore this impact further, Helou and colleagues assessed 32 patients with DKD. Patients were randomly assigned to 4 different study arms. A uniform, balanced cross-over design was implemented, allowing the researchers to effectively compare treatments with fewer participants while maintaining the same level of statistical power as randomized controlled trials.
During the study, patients received 3 months of usual care and 3 months of MSMP. This cycle was repeated twice over 12 months.
The Audit of Diabetes-Dependent Quality of Life scale was used to measure patients’ quality of life, and the Revised Summary of Diabetes Self-Care Activities was used to assess patient self-care behavior. Additionally, the Medication Events Monitoring System (MEMS) was used to determine patients’ adherence to anti-hypertensive therapy. Blood glucose control was measured via glycated hemoglobin (HbA1c) levels, and renal function was measured via serum creatinine, estimated glomerular filtration rate, and urinary albumin/creatinine ratio.
Results indicated that patients’ quality of life had improved by MSMP compared with usual care (ranked 55.95 vs 42.19).
The researchers also found that MSMP had improved patients’ general diet habits, diabetes-specific diet habits, and frequency of blood sugar testing. However, there were no significant differences between MSMP and usual care for glycemic control and renal function.
“The implementation of a nurse-led multidisciplinary self-care management program with a theory-based nursing practice improved general [quality of life] and self-care activities of DKD patients,” the researchers concluded.
—Christina Vogt
Reference:
Helou N. The impact of a multidisciplinary self-care management program on quality of life, self-care, adherence to anti-hypertensive therapy, glycemic control and renal function in diabetic kidney disease: a cross-over study. Paper presented at: 2nd Annual Kidney Congress; August 28-30, 2017. Philadelphia, PA. http://kidney.conferenceseries.com/abstract/2017/the-impact-of-a-multidisciplinary-self-care-management-program-on-quality-of-life-self-care-adherence-to-anti-hypertensive-therapy-glycemic-control-and-renal-function-in-diabetic-kidney-disease-a-cr.