Younis Kokab, McCaffrey Graham, King Shier Kathryn, Bouchal Shelley Raffin, Quinn Robert R
Faculty of Nursing, University of Calgary, AB, Canada.
Department of Medicine, University of Calgary, AB, Canada.
Can J Kidney Health Dis. 2025 Jul 29;12:20543581251359734. doi: 10.1177/20543581251359734. eCollection 2025.
Patients with both diabetes and kidney failure requiring dialysis are a complex population that is at risk of diabetes-related complications, hospitalizations, and mortality. Due to the significant illness burden, self-management of diabetes becomes challenging. The purpose of this review was to identify and synthesize the literature on barriers to, and facilitators of, diabetes self-management among patients with both diabetes and kidney failure requiring dialysis.
We conducted a search of health care databases (CINAHL, PubMed, OVID Medline) to find studies that were focused on exploring barriers to, and facilitators of, diabetes self-management in this population. We included English-language qualitative, quantitative, and mixed-methods studies.
We performed a focused narrative review assessing barriers and facilitators to diabetes management among patients with chronic kidney disease. The literature was critically analyzed using various appraisal tools, and thematic analysis was performed.
A total of 134 articles were identified. Eight articles met inclusion criteria. A review of the articles revealed barriers in diabetes self-management covering 5 themes: financial limitations, limited access to healthcare services, siloed and fragmented care, increased complexity of the dietary regimen, and the higher burden of health. Three themes were revealed pertaining to facilitators of diabetes self-management: self-management support and education, coordinated care between healthcare providers, and family support.
The literature search was in-depth and comprehensive, but not exhaustive. Also, we restricted our search criteria to articles published in the English language.
There can be challenges living with multiple chronic conditions, especially for those with comorbid diabetes and kidney failure requiring dialysis. This study underscores the urgent need for quality improvement and research initiatives to support these individuals. In addition, conducting further qualitative research to explore the perspectives of dialysis patients, their health care professionals, and caregivers would be beneficial.
患有糖尿病且肾衰竭需要透析的患者是一个复杂的群体，面临糖尿病相关并发症、住院和死亡风险。由于疾病负担沉重，糖尿病自我管理颇具挑战。本综述旨在识别并综合有关患有糖尿病且肾衰竭需要透析的患者在糖尿病自我管理方面的障碍和促进因素的文献。
我们对医疗保健数据库（CINAHL、PubMed、OVID Medline）进行了检索，以查找专注于探索该人群糖尿病自我管理障碍和促进因素的研究。我们纳入了英文的定性、定量和混合方法研究。
我们进行了一项重点叙述性综述，评估慢性肾病患者糖尿病管理的障碍和促进因素。使用各种评估工具对文献进行严格分析，并进行主题分析。
共识别出134篇文章。8篇文章符合纳入标准。对这些文章的综述揭示了糖尿病自我管理中的障碍涵盖5个主题：经济限制、获得医疗服务受限、医疗服务分散且碎片化、饮食方案复杂性增加以及更高的健康负担。还揭示了与糖尿病自我管理促进因素相关的3个主题：自我管理支持与教育、医疗服务提供者之间的协调护理以及家庭支持。
文献检索深入且全面，但并非详尽无遗。此外，我们将检索标准限制为英文发表的文章。
患有多种慢性病，尤其是患有糖尿病且肾衰竭需要透析的患者，生活中可能会面临挑战。本研究强调迫切需要开展质量改进和研究举措来支持这些个体。此外，进一步开展定性研究以探索透析患者、他们的医护人员和护理人员的观点将是有益的。
