Ozieh Mukoso N, Egede Leonard E
Department of Medicine, Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI, United States.
JMIR Form Res. 2022 Mar 15;6(3):e34029. doi: 10.2196/34029.
Behavioral factors, such as lifestyle, have been shown to explain approximately 24% of the excess risk of chronic kidney disease (CKD) among African Americans. However, there are limited intervention studies culturally tailored to African Americans with type 2 diabetes mellitus and CKD.
The main objective of this study was to examine the feasibility and preliminary efficacy of a culturally tailored lifestyle intervention among African Americans with type 2 diabetes mellitus and CKD.
A pre-post design was used to test the feasibility of a lifestyle intervention in 30 African American adults recruited from the Medical University of South Carolina between January 2017 and February 2017. A research nurse delivered the manualized study intervention weekly for 6 weeks. Clinical outcomes (hemoglobin A, blood pressure, and estimated glomerular filtration rate [eGFR]) were measured at baseline and postintervention. Disease knowledge, self-care, and behavior outcomes were also measured using validated structured questionnaires at baseline and postintervention. Descriptive statistics and effect sizes were calculated to determine clinically important changes from baseline.
Significant pre-post mean differences and decreases were observed for hemoglobin A (mean 0.75%, 95% CI 0.16-1.34; P=.01), total cholesterol (mean 16.38 mg/dL, 95% CI 5.82-26.94; P=.004), low-density lipoprotein (mean 13.73 mg/dL, 95% CI 3.91-23.54; P=.008), and eGFR (mean 6.73 mL/min/1.73m, 95% CI 0.97-12.48; P=.02). Significant pre-post mean differences and increases were observed for CKD self-efficacy (mean -11.15, 95% CI -21.55 to -0.75; P=.03), CKD knowledge (mean -2.62, 95% CI -3.98 to -1.25; P<.001), exercise behavior (mean -1.21, 95% CI -1.96 to -0.46; P=.003), and blood sugar testing (mean -2.15, 95% CI -3.47 to -0.83; P=.003).
This study provides preliminary data for a large-scale appropriately powered randomized controlled trial to examine a culturally tailored lifestyle intervention in African Americans with type 2 diabetes mellitus and CKD in order to improve clinical, knowledge, self-care, and behavior outcomes in this population.
行为因素，如生活方式，已被证明可解释非裔美国人慢性肾脏病（CKD）额外风险的约24%。然而，针对患有2型糖尿病和CKD的非裔美国人进行文化定制干预的研究有限。
本研究的主要目的是检验针对患有2型糖尿病和CKD的非裔美国人进行文化定制生活方式干预的可行性和初步疗效。
采用前后设计，测试2017年1月至2017年2月从南卡罗来纳医科大学招募的30名非裔美国成年人生活方式干预的可行性。一名研究护士每周进行一次手册化研究干预，为期6周。在基线和干预后测量临床结局（糖化血红蛋白、血压和估计肾小球滤过率[eGFR]）。还在基线和干预后使用经过验证的结构化问卷测量疾病知识、自我护理和行为结局。计算描述性统计量和效应大小，以确定与基线相比具有临床意义的变化。
糖化血红蛋白（平均0.75%，95%CI 0.16 - 1.34；P = 0.01）、总胆固醇（平均16.38mg/dL，95%CI 5.82 - 26.94；P = 0.004）、低密度脂蛋白（平均13.73mg/dL，95%CI 3.91 - 23.54；P = 0.008）和eGFR（平均6.73mL/min/1.73m²，95%CI 0.97 - 12.48；P = 0.02）观察到显著的前后平均差异及降低。CKD自我效能感（平均 - 11.15，95%CI - 21.55至 - 0.75；P = 0.03）、CKD知识（平均 - 2.62，95%CI - 3.98至 - 1.25；P < 0.001）、运动行为（平均 - 1.21，95%CI - 1.96至 - 0.46；P = 0.003）和血糖检测（平均 - 2.15，95%CI - 3.47至 - 0.83；P = 0.003）观察到显著的前后平均差异及增加。
本研究为大规模、有足够效力的随机对照试验提供了初步数据，以检验针对患有2型糖尿病和CKD的非裔美国人进行文化定制生活方式干预，从而改善该人群的临床、知识、自我护理和行为结局。
