{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:50:50Z","timestamp":1791827450517,"version":"4.3.4"},"reference-count":47,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Background<\/jats:title>\n Diabetic kidney disease (DKD) is a common complication of type 2 diabetes mellitus (T2DM) and a leading cause of end-stage renal disease, posing substantial health and economic burdens. Early self-management interventions targeting modifiable risk factors are crucial to prevent or slow DKD progression. However, most studies focus on later stages of DKD, leaving a gap in early prevention for high risk of DKD individuals.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the effectiveness of a structured self-management intervention on clinical outcomes among T2DM patients at high risk of DKD.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n A prospective, two-arm, randomized controlled trial.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n A tertiary hospital in Shandong Province, China.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n 134 patients with T2DM who were classified as being at high risk of DKD using a validated DKD risk prediction model.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n 134 participants were randomized 1:1 to the intervention or control group. The intervention group received a 12-week a structured self-management program and 12-week follow-up. The control group received usual care. Clinical outcomes included hemoglobin A1c (HbA1c), urinary albumin-to-creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), body mass index (BMI), waist circumference (WC) were collected at baseline (T0), after the 12-week intervention (T1), and at 24 weeks (T2). Generalized estimating equations and intention-to-treat analyses were performed. Sensitivity analyses using multiple imputation were conducted.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n All participants completed the intervention phase. During the follow-up visits period, 7 participants in the intervention group and 9 participants in the control group were lost to follow-up at T1 (attrition rate: 11.94%), while 5 participants in the intervention group and 4 participants in the control group were lost to follow-up at T2 (attrition rate: 6.71%). No significant differences in baseline sociodemographic or clinical indicators between participants retained and those lost to follow-up (p\u2009>\u20090.05), suggesting data were missing at random. Baseline comparisons between the intervention and control groups revealed no significant differences in demographic or clinical indicators (p\u2009>\u20090.05). Compared with the control group, the intervention group demonstrated significant improvements in HbA1c, eGFR, SBP, and LDL-C, while no significant differences were observed for UACR, BMI, or WC. Sensitivity analyses yielded consistent results.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The self-management intervention effectively improved HbA1c, eGFR, SBP and LDL-C among T2DM patients at high risk of DKD. These findings suggest that integrating structured self-management into routine diabetes care may help improve modifiable risk factors and support early DKD prevention.<\/jats:p>\n <\/jats:sec>\n \n Registration<\/jats:title>\n \n China Clinical Trial Registry (Chi\n CTR2400092745<\/jats:ext-link>\n ; registered on 22 November 2024)\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0360475","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:26:06Z","timestamp":1791825966000},"page":"e0360475","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of a self-management intervention on clinical outcomes among patients with type 2 diabetes at high risk for Diabetic Kidney Disease: A Randomised Controlled Trial"],"prefix":"10.1371","volume":"21","author":[{"given":"Dongmei","family":"Chu","sequence":"first","affiliation":[{"name":"Universiti Putra Malaysia","place":["Selangor, Malaysia"],"department":["Department of Nursing, Faculty of Medicine and Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingyang","family":"Liu","sequence":"additional","affiliation":[{"name":"Universiti Putra Malaysia","place":["Selangor, Malaysia"],"department":["Department of Nursing, Faculty of Medicine and Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim Lam","family":"Soh","sequence":"additional","affiliation":[{"name":"Universiti Putra Malaysia","place":["Selangor, Malaysia"],"department":["Department of Nursing, Faculty of Medicine and Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasni Idayu","family":"Saidi","sequence":"additional","affiliation":[{"name":"Universiti Putra Malaysia","place":["Selangor, Malaysia"],"department":["Department of Biomedical Sciences, Faculty of Medicine and Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9609-028X","authenticated-orcid":true,"given":"Salimah","family":"Japar","sequence":"additional","affiliation":[{"name":"Universiti Putra Malaysia","place":["Selangor, Malaysia"],"department":["Department of Nursing, Faculty of Medicine and Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"pone.0360475.ref001","volume-title":"IDF diabetes atlas","author":"DJ Magliano","year":"2021","edition":"10"},{"key":"pone.0360475.ref002","doi-asserted-by":"crossref","first-page":"109119","DOI":"10.1016\/j.diabres.2021.109119","article-title":"IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045","volume":"183","author":"H Sun","year":"2022","journal-title":"Diabetes Res Clin Pract"},{"issue":"10","key":"pone.0360475.ref003","doi-asserted-by":"crossref","first-page":"2864","DOI":"10.2337\/dc14-1296","article-title":"Diabetic kidney disease: A report from an ADA Consensus Conference","volume":"37","author":"KR Tuttle","year":"2014","journal-title":"Diabetes Care"},{"issue":"2","key":"pone.0360475.ref004","doi-asserted-by":"crossref","first-page":"117","DOI":"10.2174\/1570161117666190502103733","article-title":"Microvascular Complications of Type 2 Diabetes Mellitus","volume":"18","author":"C Faselis","year":"2020","journal-title":"Curr Vasc Pharmacol"},{"key":"pone.0360475.ref005","article-title":"11. 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