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The development and evaluation of a self-management package for people with diabetes at risk of chronic kidney disease

Thomas, Nicola (2010). The development and evaluation of a self-management package for people with diabetes at risk of chronic kidney disease. (Unpublished Doctoral thesis, City, University of London)


Progression of chronic kidney disease (CKD) in diabetes can be slowed by strict blood pressure and blood sugar control, prescription of medicines that modify the renin-angiotensin system and lifestyle changes, such as smoking cessation. Because of the large numbers of people with diabetes whose condition progresses (and eventually require dialysis or transplantation), it is possible that the management of their diabetes remains sub-optimal. The overall purpose of this thesis is to develop, test and evaluate an educational package to help people self-manage their risk of CKD progression. This thesis contains a case study, a critical review of literature, the main research study and an artefact (the self-management package).

The case study developed from a three-month observation period in six general practitioner (GP) practices. The literature review evaluates the effect of patient education and selfmanagement on diabetes control and outcomes. The research project develops and evaluates the self-management package. Development of the package was informed by the findings of the case study and literature review, and also through interviews with 15 people at high risk of CKD progression. The resulting self-management package comprises written information; a 20-minute DVD filmed with patients; a fridge magnet (with key messages); a monitoring diary; and a blood pressure machine if required. Testing of the package was undertaken in the same six practices mentioned above, with one additional control practice. Patients with Type 1 or Type 2 diabetes at risk of kidney disease were included. Data on renal function (serum creatinine, eGFR and proteinuria), systolic and diastolic blood pressure (BP), glycated haemoglobin (HbA1c), body mass index (BMI) and smoking status were collected at six time points, before, during and after the intervention. Outcomes in patients in the participating surgeries who did receive a pack (n=116) were compared with patients in the control group (n=61).

At time point 4 mean systolic BP in the intervention group was 129.2 ± 19.2 mmHg vs. 134.6 ± 15.0 mmHg in the control group (p=0.057). At time point 5 there was mild significance (p=0.053) in mean diastolic BP. At the end of the study (time point 6) the intervention group had a mean systolic BP of 132.1 ± 14.2 mmHg vs. 136.2 ± 16.4 mmHg and mean diastolic BP of 74.9 ± 8.5 mmHg vs. 77.6 ± 9.1mmHg in the control group (p=ns). There were no significant differences in HbA1c and BMI at any time period.

The results of the research project have shown the importance of self-management techniques to control blood pressure, which in turn can slow the rate of CKD progression and reduce cardio-vascular risk. Following evaluation by patients, the self-management package has been amended and strategies for local and national dissemination of the package have been put in place.

Publication Type: Thesis (Doctoral)
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments: Doctoral Theses
School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses
School of Health & Psychological Sciences > Healthcare Services Research & Management
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