Updated management of chronic kidney disease in patients with diabetes

Impact of patient-centred diabetes self-management education targeting people with type 2 diabetes: an integrative review

AIMS

To synthesize primary research into the impact of person-centred diabetes self-management education, and support that targets people with type 2 diabetes, on behavioural, psychosocial and cardiometabolic outcomes and to identify effective mechanisms underlying positive outcomes of person-centred diabetes self-management education and support.

METHODS

Using Whittemore and Knafl's integrative review method, we conducted a systematic search of peer-reviewed literature published between January 2008 and June 2019 using PubMed, Scopus and CINAHL. After article selection according to established criteria, study quality was assessed using Critical Appraisal Skills Programme checklists for cohort studies, randomized controlled trials and qualitative research.

RESULTS

From 1901 identified records, 22 (19 quantitative, two qualitative, and one mixed methods) were considered eligible for inclusion. Interventions were categorized by content, medium of delivery, and outcomes. Qualitative studies, quantitative cohort studies and randomized controlled trials demonstrated positive outcomes, with no differences in success rates across study design. Interventions were largely successful in improving HbA_1c and patient-reported outcomes such as quality of life but had limited success in lowering cholesterol and weight, or initiating long-term improvements in lifestyle behaviours. Primary objectives were achieved more often than secondary objectives, and studies with fewer outcomes appeared more successful in achieving specific outcomes.

CONCLUSIONS

Person-centred diabetes self-management education and support has demonstrated a considerable impact on desired diabetes-related outcomes in people with type 2 diabetes. To advance the field further, new studies should take advantage of systematic and transparent approaches to person-centred diabetes self-management education.

SUDOSCAN, an effective tool for screening chronic kidney disease in patients with type 2 diabetes

SUDOSCAN is a non-invasive method of measuring peripheral small fiber and autonomic nerve activity by detection of abnormal sweat gland function through electrochemical skin conductance. It has been reported to be an effective screening tool in early detection of microvascular type 2 diabetes mellitus (T2DM) complications including diabetic neuropathy and nephropathy in recent studies. However, previous studies used estimated glomerular filtration rate (eGFR) as the golden standard, which has a 90% chance of being within 30% of the measured GFR at best. No relevant study has been performed in the Chinese population concerning SUDOSCAN in the screening of diabetic nephropathy (DN) in comparison with GFR. In this cross-sectional study, SUDOSCAN was performed in 176 Chinese patients with T2DM between September 2014 and September 2015. It was found that the SUDOSCAN test had a sensitivity of 57.8% and a specificity of 100% to detect chronic kidney disease at a cut-off SUDOSCAN-DN score of 59.5. The area under receiver operating characteristic curve for DN was 0.85 [95% confidence interval (CI), 0.76-0.93] compared with 0.84 for eGFR_MDRD (MDRD, modification of diet in renal disease; 95% CI, 0.71-0.98) and 0.77 for eGFR_EPI (EPI, epidemiology collaboration; 95% CI, 0.68-0.87). Patients with DN score <59.5 had a significantly lower GFR level (P<0.001) and significantly older age (P<0.001), longer duration of T2DM (P<0.001) and higher risk of diabetic complications, including diabetic neuropathy (P<0.001) and peripheral vascular disease (P<0.05). These results suggested that SUDOSCAN may be useful for detecting patients at risk of impaired renal function as part of a screening program in the Chinese population with T2DM.