Background: Diabetic kidney disease, a global health issue, remains associated with high morbidity and mortality.\nPrevious research has shown that multidisciplinary management of chronic disease can improve patient outcomes.\nThe effect of multidisciplinary self-care management on quality of life and renal function of patients with diabetic\nkidney disease has not yet been well established.\nMethod/Design: The aim of this study is to evaluate the impact of a multidisciplinary self-care management program\non quality of life, self-care behavior, adherence to anti-hypertensive treatment, glycemic control, and renal function of\nadults with diabetic kidney disease. A uniform balanced cross-over design is used, with the objective to recruit 40 adult\nparticipants with diabetic kidney disease, from public and private out-patient settings in French speaking Switzerland.\nParticipants are randomized in equal number into four study arms. Each participant receives usual care alternating with\nthe multidisciplinary self- care management program. Each treatment period lasts three months and is repeated twice at\ndifferent time intervals over 12 months depending on the cross-over arm. The multidisciplinary self-care management\nprogram is led by an advanced practice nurse and adds nursing and dietary consultations and follow-ups, to the habitual\nmanagement provided by the general practitioner, the nephrologist and the diabetologist. Data is collected\nevery three months for 12 months. Quality of life is measured using the Audit of Diabetes-Dependent Quality of\nLife scale, patient self-care behavior is assessed using the Revised Summary of Diabetes Self-Care Activities, and\nadherence to anti-hypertensive therapy is evaluated using the Medication Events Monitoring System. Blood\nglucose control is measured by the glycated hemoglobin levels and renal function by serum creatinine, estimated\nglomerular filtration rate and urinary albumin/creatinine ratio. Data will be analyzed using STATA version 14.Discussion: The cross-over design will elucidate the responses of individual participant to each treatment, and will\nallow us to better evaluate the use of such a design in clinical settings and behavioral studies. This study also explores\nthe impact of a theory-based nursing practice and its implementation into a multidisciplinary context.
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