Document Detail

Education programmes for people with diabetic kidney disease.
MedLine Citation:
PMID:  21678365     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Adherence to complex regimens for patients with diabetic kidney disease (DKD) is often poor. Interventions to enhance adherence require intensive education and behavioural counselling. However, whether the existing evidence is scientifically rigorous and can support recommendations for routine use of educational programmes in DKD is still unknown.
OBJECTIVES: To evaluate the benefits and harms of education programmes for people with DKD.
SEARCH STRATEGY: In January 2010 we searched the Cochrane Renal Group's Specialised Register, CENTRAL, MEDLINE, EMBASE and four Chinese medicine databases (CBM-disc, Chinese Science and Technique Journals Database, China National Infrastructure and WanFang).
SELECTION CRITERIA: All randomised controlled trials (RCTs) and quasi-RCTs studying the benefits and harms of educational programmes for people with DKD.
DATA COLLECTION AND ANALYSIS: Two authors independently searched the literature, determined study eligibility, assessed quality, extracted and entered data. We expressed dichotomous outcomes as risk ratios (RR) with 95% confidence intervals (CI) and continuous data as mean difference (MD) or standardised mean differences (SMD). Data were pooled using the random effects model.
MAIN RESULTS: Two studies (207 patients) were eligible. The methodological quality was not high. Compared with no educational programmes, educational programmes for patients with diabetes on dialysis improved patients' knowledge for the following outcomes: diagnosis (SMD 1.14, 95% CI 0.93 to 1.90); monitoring (SMD 1.51, 95% CI 1.0 to 2.01); hypoglycaemia (SMD 1.67, 95% CI 1.16 to 2.17), hyperglycaemia (SMD 0.80, 95% CI 0.35 to 1.25); medication with insulin (SMD 1.21, 95% CI 0.74 to 1.68); oral medication (SMD 0.98, 95% CI 0.52 to1.43); personal health habits (SMD 1.84, 95% CI 1.33 to 2.36); diet (SMD 0.53, 95% CI 0.09 to 0.97); exercise (SMD 1.13, 95% CI 0.67 to 1.60); chronic complications (SMD 1.28, 95% CI 0.80 to1.75) and living with diabetes and coping with stress (SMD 0.71, 95% CI 0.26 to 1.15). For patients with diabetes and microalbuminuria, educational programmes improved general knowledge for the following outcomes: diabetes (SMD 0.84, 95% CI 0.43 to 1.26); patients' total self-efficacy (MD 19.00, 95% CI 12.58 to 25.42) and patients' changes in beliefs on treatment effectiveness (MD 0.25, 95% CI 0.07 to 0.43) at the end of treatment, and general knowledge (MD 14.39, 95% CI 7.45 to 21.33); specific self-efficacy in home blood glucose monitoring (HBGM) (MD 11.28, 95% CI 1.92 to 20.64) and changes of beliefs on personal control (MD 0.31, 95% CI 0.01 to 0.61) at the end of three-months follow-up. For patients with diabetes on dialysis, educational programmes also showed improvement in the following self-management behaviours: checking feet (RR 1.63, 95% CI 1.01 to 2.63); using lotion (RR 9.71, 95% CI 2.45 to 38.56) and wearing appropriate shoes and socks (RR 4.39, 95% CI 1.87 to 10.32). For patients with diabetes and microalbuminuria, educational programmes improved the following behaviours: general diet (MD 0.73, 95% CI 0.10 to 1.36), specific diet (MD 1.02, 95% CI 0.42 to1.62) and HBGM (MD 2.13, 95% CI 1.18 to 3.08) at the end of treatment; and specific diet (MD 0.62, 95% CI 0.18 to 1.06) and HBGM (MD 1.48, 95% CI 0.48 to 2.48) at the end of three-months follow-up. No data were available on changes in kidney function, incidence of cardiovascular events, change of patients' attitude or adverse events.
AUTHORS' CONCLUSIONS: Education programmes appear to have beneficial effects on improving patients' knowledge of diabetes and some self-management behavioural changes for patients with diabetes on dialysis or with microalbuminuria. Educational programmes appear to have beneficial effects on improving patients' self-efficacy and result in some beliefs changes for patients with diabetes and microalbuminuria. However, only two studies with small sample sizes and inadequate quality were included in this review. There is, therefore, inadequate evidence to support the beneficial effects of education programmes for people with DKD.
Ting Li; Hong Mei Wu; Feng Wang; Chang Quan Huang; Ming Yang; Bi Rong Dong; Guan J Liu
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review     Date:  2011-06-15
Journal Detail:
Title:  The Cochrane database of systematic reviews     Volume:  -     ISSN:  1469-493X     ISO Abbreviation:  Cochrane Database Syst Rev     Publication Date:  2011  
Date Detail:
Created Date:  2011-06-16     Completed Date:  2011-08-24     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  100909747     Medline TA:  Cochrane Database Syst Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  CD007374     Citation Subset:  IM    
Department of Geriatrics, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan, China, 610041.
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MeSH Terms
Diabetic Nephropathies* / diagnosis,  therapy
Health Knowledge, Attitudes, Practice*
Patient Compliance
Patient Education as Topic*
Program Evaluation
Randomized Controlled Trials as Topic
Self Care / methods*

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