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

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• 作者：F. Jiao^a ; ^{francesj@connect.hku.hk} ; C.S.C. Fung^a ; ^cfsc@hku.hk ; Y.F. Wan^a ; ^yfwan@hku.hk ; S.M. McGhee^b ; ^{sarahmcghee7@gmail.com} ; C.K.H. Wong^a ; ^{carlosho@hku.hk} ; D. Dai^c ; ^{ddai@ha.org.hk} ; R. Kwok^c ; ^{kwoklp@ha.org.hk} ; C.L.K. Lam^a ; ^{clklam@hku.hk}
• 关键词：Diabetes mellitus ; Microvascular complications ; Multidisciplinary ; Risk stratification
• 刊名：Diabetes & Metabolism
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：42
• 期：6
• 页码：424-432
• 全文大小：1100 K
• 卷排序：42

文摘

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.MethodsThis 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.ResultsAfter 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.ConclusionThe 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 registryNCT02034695, www.ClinicalTrials.gov.