Summary: In a single-centre, two-arm randomized controlled trial of 92 patients with type 2 diabetes and early-stage chronic kidney disease in Taiwan, a 6-month health coaching programme added to usual care was associated with a within-group eGFR rise of 7.92 mL/min/1.73 m2 at 3 months (p=.003) and 7.63 mL/min/1.73 m2 at 6 months (p<.001), concentrated in patients whose eGFR had been worsening before enrolment. The usual-care group showed no significant change in eGFR or urinary albumin/creatinine ratio. No between-group contrast statistic, confidence interval, or albuminuria benefit was reported.
PICO Summary
| Element | Detail |
|---|---|
| Population | 92 adults with type 2 diabetes and early-stage CKD followed under a shared-care system; two-arm randomized controlled trial at a single medical centre in Taiwan. |
| Intervention | Structured 6-month health coaching programme added to usual care (open-label behavioural intervention). |
| Comparison | Usual care alone, without health coaching. |
| Outcome | Within-group eGFR change in the coaching arm: +7.92 mL/min/1.73 m2 at 3 months (p=.003) and +7.63 mL/min/1.73 m2 at 6 months (p<.001), seen mainly in patients with prior eGFR decline. Usual-care arm: no significant change in eGFR or urinary albumin/creatinine ratio (UACR). No between-group effect estimate, 95% CI, or ARR/NNT reported (continuous outcome); baseline use of nutrition supplements was flagged as a modifier. |
Expert Commentary
This is a small, single-centre randomized trial that should be read as hypothesis-generating rather than practice-changing. The headline eGFR gains are within-group changes in the coaching arm, not a head-to-head between-group difference, and they were concentrated in the subset whose filtration had been falling before enrolment, so regression to the mean cannot be excluded. No between-arm effect estimate, confidence interval, or number-needed-to-treat is offered, and the albuminuria measure (UACR) did not move, which tempers any claim of true renal protection. With only 92 participants and a behavioural intervention that cannot be blinded, the open-label design leaves room for measurement and engagement effects, and the signal that baseline nutrition-supplement use modified the response hints at residual confounding. No industry or manufacturer sponsorship is apparent, which is reassuring, but the effect size is large enough for early-stage CKD that independent replication is warranted before it is trusted. Verdict: a plausible, encouraging but fragile signal that structured coaching may help selected patients, not proof of benefit. Can I use this with my patients? Cautiously, for a motivated person with early diabetic kidney disease and a recent eGFR decline who wants structured self-management support alongside standard care, framed as adjunctive rather than proven nephroprotection. Larger, multi-centre trials with between-group analysis and hard renal endpoints are needed before this earns a firm place in care.
References
Lin CL, Chang YT, Huang LC, Chen RY, Yang SH. Effectiveness of Health Coaching in Early-Stage Chronic Kidney Diseases in Patients With Diabetes. Health Educ Behav. 2025;52(3):278-288. doi:10.1177/10901981241303697