Summary: In 56 older adults with nephrotic syndrome and steroid-induced diabetes mellitus, a 6-month mobile educational platform produced significantly greater reductions in fasting and postprandial blood glucose than routine care (P<0.001), with modest gains in diabetes self-efficacy (4.42 vs 4.15, P=0.020) and a reported 25% relative improvement in treatment adherence. This is a small, single-centre, open-label trial, so the findings are preliminary rather than definitive.
PICO Summary
| Element | Detail |
|---|---|
| Population | 56 patients with nephrotic syndrome and steroid-induced diabetes mellitus; mean age 69.0 ± 10.5 years, mean diabetes duration 7.2 ± 3.5 years. Single-centre randomised controlled trial, convenience sampling, one hospital in China (2019–2020). |
| Intervention | Health management delivered through a mobile educational platform (interactive self-management and glycaemic-control education), 6 months (n=28). |
| Comparison | Routine health management without the mobile platform (n=28). |
| Outcome | At 6 months the intervention group had significantly lower fasting and postprandial blood glucose than controls (P<0.001); absolute values, between-group differences and 95% CIs were not reported in the abstract. Diabetes Self-Efficacy Scale improved 4.42 ± 0.53 vs 4.15 ± 0.56 (P=0.020). Treatment adherence was reported as 25% higher in the intervention group (relative improvement). No adverse-event data were reported. NNT/ARR not calculable from the available data. |
Mobile education in steroid-induced diabetes
RCT · nephrotic syndrome + SDM · 6 months
A 6-month mobile education platform improved diabetes self-efficacy (4.42 vs 4.15, P=0.020), adherence and glucose control versus routine care, but this single-centre trial of 56 patients is preliminary.
Expert Commentary
This randomised trial offers an encouraging but limited signal that structured mobile education can support glycaemic control in a difficult population: older patients whose diabetes is driven by the steroids needed to treat nephrotic syndrome. The direction of effect is consistent and the statistical significance for fasting and postprandial glucose is strong on paper, yet the evidence should be read cautiously. The headline weakness is sample size and design: 56 patients recruited by convenience sampling at a single centre, with an education intervention that cannot be blinded, leaves the result vulnerable to performance and reporting bias, and the trial was registered retrospectively several years after enrolment. The abstract reports P values and a relative adherence figure but not the absolute glucose changes, between-group differences, or confidence intervals, so the magnitude and clinical importance of the benefit cannot be judged. Can I use this with my patients? Not yet as a practice-changing tool, but the concept is reasonable to trial informally with motivated, technologically comfortable patients on steroid-induced hyperglycaemia, alongside standard monitoring rather than in place of it. There was no industry sponsorship disclosed in the abstract, and the effect sizes are plausible rather than implausibly large. What this field needs is a larger, multicentre, adequately powered trial reporting absolute glycaemic endpoints, HbA1c, hypoglycaemia and safety, before mobile platforms can be recommended as standard care in this setting.
References
Yang Z, Tan Z, Sun M, Zhang J, Hou H, Li X. Positive impact of mobile educational platforms on blood glucose control in patients with nephrotic syndrome and steroid-induced diabetes mellitus: a randomized controlled study. BMC Endocr Disord. 2025;25(1):118. doi:10.1186/s12902-024-01802-2