The Diabetes Complications and Control Trial (DCCT) reported delayed onset of diabetic nephropathy in patients with type 1 diabetes receiving intensive therapy including monthly visits with a dietitian for self-management training of self-blood glucose monitoring, keeping food records and adjusting diet and physical activity based on records.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Only the Modification of Diet in Renal Disease Study (MDRD) of all of the intervention studies in which dietary protein was restricted to 0.3 to 0.6 g/kg/IBW (+ amino acids or keto acids) reported the details of self-management training and self-monitoring (food records). All of the studies, however, reported monthly visits with the dietitian. Secondary analysis of the MDRD study showed a decline in the progression of chronic kidney disease in subjects with a glomerular filtration rate (GFR) ~15 ml/min. Dietary compliance increased with self-monitoring, satisfaction with the diet and feedback (dietary intake from food records and urinary urea nitrogen) and support from the dietitian.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Only one of the three studies (two randomized controlled trials and one nonrandomized trial with concurrent controls) in subjects with nephrotic syndrome were free-living and the study period was one month. This study was a randomized controlled trial and dietary compliance was monitored with weekly diet records and urinary urea nitrogen determinations, however, no details of self-management training were described. There was a significant decrease in urine protein and an increase in serum albumin in the free-living subjects following a diet containing 0.6 g protein + 1 g protein for each g of urinary protein.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.