Team-Based Empowerment Care Improves Clinical Outcomes for Patients With Diabetic Kidney Disease

Physicians collaborating on computer
A multicenter randomized controlled trial was conducted to assess the impact of a web-based, diabetes evaluation portal and team-based care on outcomes in patients with diabetic kidney disease.

A technology-assisted, team-based empowerment care program was found to be associated with attainment of treatment targets among patients with diabetic kidney disease, according to results of a study published in JAMA Network Open.

Between 2014 and 2019, patients with diabetic kidney disease  were recruited for this multinational, open-label, 3-group, randomized clinical trial from 13 centers in 8 countries or regions in Asia. Patients (N=2393) were randomly assigned in a 1:1:1 ratio to receive usual care (n=795), empowered care (n=802), or team-based care (n=796) for 12 months. All participants underwent a Joint Asia Diabetes Evaluation (JADE) web portal-guided structured assessment at baseline and month 12. In addition, the empowerment care group received a personalized JADE report and were contacted by telephone by a nurse every 3 months, and the team-based empowerment care group participated in a face-to-face review by a nurse-physician team every 3 months. The primary targets were the achievement of healthy glycated hemoglobin (HbA1C); blood pressure (BP); cholesterol and triglyceride levels; and cessation of medications for diabetic kidney disease.

The mean age of the study population was 67.7 (standard deviation [SD], 9.8) years, age at diabetes diagnosis was 51.2 (SD, 11.6) years, 52.9% were men, body mass index (BMI) was 26.9 (SD, 4.8) kg/m2, HbA1C was 7.9% (SD, 1.6%), systolic BP was 139.0 (SD, 18.6) mm Hg, diastolic BP was 74.3 (SD, 11.1) mm Hg, low-density lipoprotein cholesterol (LDL-C) was 2.4 (SD, 1.1) mmol/L, triglyceride level was 1.9 (SD, 1.3) mmol/L, and estimated glomerular filtration rate (eGFR) was 49.8 (SD, 16.3) mL/min/1.73 m2.

At 12 months, 85.3% to 87.4% of the 3 treatment groups underwent the follow-up assessment. Patients who were lost to follow-up had poorer risk factor control at baseline (P <.001).

Compared with baseline, 3.9% more patients in the usual care, 1.3% in the empowerment group, and 9.1% in the team-based empowerment care group achieved at least 3 treatment targets. These changes from baseline were not significantly different within or between the usual care and empowerment cohorts. The team-based empowerment care intervention was associated with significant improvements from baseline (P <.001) and compared with usual care (adjusted risk ratio [aRR], 1.20; 95% CI, 1.03-1.40; P =.02) or empowerment care (aRR, 1.27; 95% CI, 1.07-1.49; P =.005).

Stratified by cardiometabolic risk factors, the team-based empowerment care group experienced significant improvements in HbA1C (mean difference [MD], -0.39% vs -0.18% vs -0.15%; P =.004), total cholesterol (MD, -0.12 vs 0.02 vs 0.04 mmol/L; P =.046), LDL-C (MD, -0.14 vs 0.02 vs 0.09 mmol/L; P =.001), urinary albumin-to-creatinine ratio (MD, 4.12 vs 21.1 vs 10.49 mg/mmol; P =.03), and engaging in at least 2 self-care activities (MD, 7.3% vs 1.3% vs 2.7%; P =.02) compared with the usual care and empowerment care groups, respectively. The team-based empowerment group also demonstrated increased uptake of lipid-lowering agents (MD, 1.2% vs -4.6% vs -1.8%; P =.04).

This study may have been limited by including patients with mild diabetic kidney disease. It also remains unclear whether the findings of this study would be generalizable to patients with severe diabetic kidney disease.

The researchers found that more patients with diabetic kidney disease who received team-based empowerment care were able to reach treatment targets.

Disclosure: Multiple authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please refer to the original article for a full list of disclosures.


Chan JCN, Thewjitcharoen Y, Nguyen TK, et al. Effect of a web-based management guide on risk factors in patients with type 2 diabetes and diabetic kidney disease: a JADE randomized clinical trial. JAMA Netw Open. Published online March 25, 2022. doi:10.1001/jamanetworkopen.2022.3862