Primary Health Care Research & Development


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

Nicola Thomasa1 c1 and Rosamund Bryara2

a1 Independent Renal Nursing Consultant, Renal Nurse Consulting, The Horseshoe, Coulsdon, Surrey, UK

a2 Professor of Community and Primary Care Nursing, School of Health Sciences, City University London, London, UK


Aims and objectives The overall purpose was to develop, test and evaluate an educational package to help people with diabetes self-manage their risk of developing chronic kidney disease (CKD), one of the main complications of diabetes.

Background Management of people in primary care who have both CKD and diabetes can be controlled by strict blood pressure (BP) and blood sugar control and advice on lifestyle changes, such as smoking cessation. However, there is little evidence to support the assertion that self-management can slow the rate of kidney disease progression.

Design A mixed-method longitudinal study. Development of the self-management package was informed by the findings of a case study in six GP Practices and also through interviews with 15 patients.

Methods Testing of the self-management package was undertaken in the same six Practices, with one additional control Practice. Patients with Type 1 or Type 2 diabetes at risk of kidney disease were included. Outcomes in patients in the participating surgeries who did receive a pack (n = 116) were compared with patients in the control group (n = 60) over 6 time points.

Results At the end of the study (time point 6), the intervention group had a mean systolic BP of 4.1 mmHg lower and mean diastolic BP of 2.7 mmHg lower than in the control group.

Conclusion Self-management techniques such as understanding of, and subsequent concordance with, prescribed BP medication may contribute to a reduction in BP, which in turn will reduce cardiovascular risk.

Relevance to clinical practice: This study contributes to the evidence base for self-management of early kidney disease. Although the exact reason for reduced BP in the intervention group is unclear, the importance of practitioner understanding of kidney disease management and patient understanding of BP medication are likely to be the contributing factors.

(Received July 05 2012)

(Revised September 13 2012)

(Accepted October 14 2012)

(Online publication January 15 2013)

Key words

  • blood pressure;
  • chronic kidney disease;
  • diabetes mellitus;
  • self-management


c1 Correspondence to: Dr Nicola Thomas, Renal Nurse Consulting, 10, The Horseshoe, Coulsdon CR5 2AS, Surrey, UK. Email: