Effectiveness of the multidisciplinary Risk Assessment and Management Program for Patients with Diabetes Mellitus (RAMP-DM) for diabetic microvascular complications: A population-based cohort study.

F Jiao, C S C Fung, Y F Wan, S M McGhee, C K H Wong, D Dai, R Kwok, C L K Lam

Journal: Diabetes & metabolism 2017;42(6):424-432

PMID: 27568125

Full Text on Elsevier Science View on PubMed

Abstract

AIM

To evaluate the effectiveness of the multidisciplinary Risk Assessment and Management Program for Patients with Diabetes Mellitus (RAMP-DM) in reducing the risks of microvascular complications.

METHODS

This prospective cohort study was conducted with 29,670 propensity-score-matched RAMP-DM participants and diabetes patients under the usual primary care (14,835 in each group). Study endpoints were the first occurrence of any diabetic microvascular complications, non-proliferative diabetic retinopathy/preproliferative diabetic retinopathy (NPDR/prePDR), sight-threatening diabetic retinopathy (STDR) or blindness, nephropathy, end-stage renal disease (ESRD), neuropathy and lower-limb ulcers or amputation. Log-rank tests and multivariable Cox proportional-hazards regressions were employed to estimate between-group differences in incidences of study endpoints.

RESULTS

After a median follow-up of 36 months with>41,000 person-years in each group, RAMP-DM participants had a lower incidence of microvascular complications (760 vs 935; adjusted hazard ratio [HR]: 0.73; 95% confidence interval [CI]: 0.66-0.81; P<0.001) and lower incidences of all specific microvascular complications except neuropathy (adjusted HR: 0.94; 95% CI: 0.61-1.45; P=0.778). Adjusted HRs for the RAMP-DM vs control group for ESRD, STDR or blindness, and lower-limb ulcers or amputation were 0.40 (95% CI: 0.24-0.69; P<0.001), 0.55 (95% CI: 0.39-0.78; P=0.001) and 0.49 (95% CI: 0.30-0.80; P=0.005), respectively.

CONCLUSION

The RAMP-DM intervention was associated with lower incidences of all microvascular complications except neuropathy over a 3-year follow-up. These encouraging results constitute evidence that structured risk assessment and risk-stratified management provided by a multidisciplinary team is effective for reducing microvascular complications in diabetes patients.

CLINICAL TRIAL REGISTRY

NCT02034695, www.ClinicalTrials.gov.

Address: The University of Hong Kong, Li Ka Shing Faculty of Medicine, Department of Family Medicine and Primary Care, 3/F Ap Lei Chau Clinic, 161, Main Street, Ap Lei Chau, Hong Kong. Electronic address: [email protected].; The University of Hong Kong, Li Ka Shing Faculty of Medicine, Department of Family Medicine and Primary Care, 3/F Ap Lei Chau Clinic, 161, Main Street, Ap Lei Chau, Hong Kong. Electronic address: [email protected].; The University of Hong Kong, Li Ka Shing Faculty of Medicine, Department of Family Medicine and Primary Care, 3/F Ap Lei Chau Clinic, 161, Main Street, Ap Lei Chau, Hong Kong. Electronic address: [email protected].; The University of Hong Kong, School of Public Health, Li Ka Shing Faculty of Medicine, 5/F William MW Mong Block, 21, Sassoon Road, Pokfulam, Hong Kong. Electronic address: [email protected].; The University of Hong Kong, Li Ka Shing Faculty of Medicine, Department of Family Medicine and Primary Care, 3/F Ap Lei Chau Clinic, 161, Main Street, Ap Lei Chau, Hong Kong. Electronic address: [email protected].; Hong Kong Hospital Authority, Hospital Authority Head Office, Hong Kong, Primary and Community Services, Hospital Authority Building, 147B Argyle Street, Kowloon, Hong Kong. Electronic address: [email protected].; Hong Kong Hospital Authority, Hospital Authority Head Office, Hong Kong, Primary and Community Services, Hospital Authority Building, 147B Argyle Street, Kowloon, Hong Kong. Electronic address: [email protected].; The University of Hong Kong, Li Ka Shing Faculty of Medicine, Department of Family Medicine and Primary Care, 3/F Ap Lei Chau Clinic, 161, Main Street, Ap Lei Chau, Hong Kong. Electronic address: [email protected].

DOI: 10.1016/j.diabet.2016.07.030

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MeSH Terms: Aged, Diabetic Angiopathies, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Prospective Studies, Risk Assessment