the Self-Management Interventions and Kidney Outcomes in Type 2 Diabetes: A Systematic Review of Randomized Trials
DOI:
https://doi.org/10.33755/jkk.v12i4.1048Keywords:
chronic kidney disease, DM tipe 2, randomized controlled trials, self-management, Systematic ReviewAbstract
Background: Whether structured self-management interventions preserve kidney function in adults with type 2 diabetes remains unclear, particularly when renal outcomes are secondary or exploratory.
Objective: To synthesize randomized evidence on kidney outcomes after behavioral, digital, educational, or exercise-based self-management support in type 2 diabetes.
Methods: PubMed, Scopus, and ScienceDirect were searched for January 2016–July 2026 publications. Six trial reports were narratively reviewed, distinguishing kidney-specific trials from indirect renal analyses. The original review used RoB 2; domain-level verification remains incomplete.
Results: DialBetesPlus improved UACR versus control but not eGFR; short-term behavioral and exercise trials showed mixed renal markers. The REACH renal subanalysis and a two-year activity trial did not establish significant overall effects on eGFR outcomes. Primary and analyzed sample denominators differed across reports.
Conclusion: Self-management may complement diabetes and kidney care, but consistent slowing of CKD progression is not demonstrated. Longer trials with standardized kidney endpoints and verified outcome-specific bias assessments are required.
References
1. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2024;105(4 Suppl):S117–S314.
2. Mallamaci F, Tripepi G. Risk factors of chronic kidney disease progression: between old and new concepts. J Clin Med. 2024;13(3):678. doi:10.3390/jcm13030678.
3. Welch JL, Johnson M, Zimmerman L, Russell CL, Perkins SM, Decker BS. Self-management interventions in stages 1 to 4 chronic kidney disease: an integrative review. West J Nurs Res. 2015;37(5):652–678. doi:10.1177/0193945914551007.
4. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71.
5. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. doi:10.1136/bmj.l4898.
6. Waki K, Nara M, Enomoto S, Mieno M, Kanda E, Sankoda A, et al. Effectiveness of DialBetesPlus, a self-management support system for diabetic kidney disease: randomized controlled trial. NPJ Digit Med. 2024;7:104. doi:10.1038/s41746-024-01114-8.
7. Chan JCN, Thewjitcharoen Y, Nguyen TK, Tan A, Chia YC, Hwu CM, et al. Effect of a web-based management guide on risk factors in patients with type 2 diabetes and diabetic kidney disease: a JADE randomized clinical trial. JAMA Netw Open. 2022;5(3):e223862. doi:10.1001/jamanetworkopen.2022.3862.
8. Suvamat J, Powwattana A, Thaingtham W, Pichayapinyo P, Boonlue S. Effectiveness of program to slow progression of chronic kidney disease among T2DM with HT with CKD 3 in the community: a randomized controlled trial. J Prim Care Community Health. 2023;14:21501319231210619. doi:10.1177/21501319231210619.
9. Roddy MKK, Mayberry LS, Nair D, Cavanaugh KL. Exploring mHealth potential to improve kidney function: secondary analysis of a randomized trial of diabetes self-care in diverse adults. BMC Nephrol. 2022;23(1):280. doi:10.1186/s12882-022-02885-6.
10. Nataraj M, Maiya GA, Nagaraju SP, Shastry BA, Shivashankara KN, Shetty S, et al. Effect of exercise-based rehabilitation on functional capacity and renal function in type 2 diabetes mellitus with nephropathy: a randomized controlled trial. Int Urol Nephrol. 2024;56(8):2671–2682. doi:10.1007/s11255-024-03987-w.
11. Hadjadj S, Ragot S, Durocher L, Bigot-Corbel E, Kessler L, Tauveron I, et al. Impact of high intensity physical activity compared to routine counseling on renal function decline in patients with type 2 diabetes at high risk for kidney disease. Diabetes Metab. 2026;52(4):101772. doi:10.1016/j.diabet.2026.101772.
