Development of a Care Model to Delay Kidney Function Decline in Type 2 Diabetes Patients with Stage 3-4 Kidney Disease

Abstract

This research and development study aimed to develop a care model to slow kidney deterioration in patients with type 2 diabetes and stage 3-4 chronic kidney disease (CKD) at the Don Phlai community health center, Chok Chai district, Nakhon Ratchasima province. The study involved 35 patients with type 2 diabetes at CKD stages 3–4 and 10 relevant healthcare personnel. The research was conducted from February 2024 to October 2024 in three phases: (1) assessing the current situation and development needs, (2) designing, validating, and piloting the care model, and (3) implementing the model to evaluate its effectiveness. Data collection tools included focus group guidelines, model structured assessment forms, self-management behavior questionnaires for slowing kidney deterioration, and clinical outcome records. Data were analyzed using frequencies, percentages, means, standard deviations, paired t-tests, and content analysis. The results from the situational analysis phase identified challenges with both the care process and patient outcomes. In the model development phase, a care model comprised of four key components(case management, diabetes education, self-management skill enhancement, and social support) was developed. The evaluation phase revealed that patients who participated in the program had significantly higher self-management behavior scores (p<.05) compared to before implementation. Additionally, 45.72% of patients demonstrated improved HbA1c levels, all maintained their kidney filtration rate within the same CKD stage, and 37.14% showed an increase in estimated glomerular filtration rate (eGFR). These findings indicate that the developed care model effectively promotes self-management behavior, improves blood sugar control, and slows kidney deterioration in patients with type 2 diabetes and stage 3-4 CKD.