Effects of Self-management Interventions on Diabetic Kidney Disease Progression and Related Health Behaviors in Type 2 Diabetes Mellitus: A Systematic Review

Abstract

Context: Diabetic kidney disease (DKD), a common complication of diabetes, affects approximately 20%-40% of patients with diabetes and may progress to end-stage renal disease if not appropriately managed. Modifiable factors influencing DKD progression can be addressed through self-management. However, the effects of self-management interventions on clinical outcomes and self-care behaviors remain unclear. This systematic review evaluated the evidence on the impact of self-management interventions on DKD progression and related health behaviors among patients with type 2 diabetes mellitus (T2DM). Evidence Acquisition: This systematic review followed the PRISMA guidelines. Nine databases and one trial register were searched from inception to August 2025 for English- and Chinese-language studies of any design that evaluated self-management interventions targeting DKD progression. Three reviewers independently screened studies and assessed eligibility. Study quality was evaluated using the Cochrane risk-of-bias assessment tools, and data were extracted using a standardized form. Results: Twelve studies were included in the qualitative analysis. Nine studies reported improvements in glycemic control, and four reported improvements in renal function. Evidence regarding blood pressure, lipid profiles, and weight-related outcomes varied across studies. Eight studies reported improved self-management behaviors, and three reported improved self-efficacy. In addition, five studies suggested potential benefits for quality of life and mental health outcomes. Overall, the included studies suggested that self-management interventions may provide multidimensional benefits for patients with T2DM and DKD or those at high risk of DKD.