F Jiao1, C S C Fung2, Y F Wan3, S M McGhee4, C K H Wong5, D Dai6, R Kwok7, C L K Lam8. 1. 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: francesj@connect.hku.hk. 2. 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: cfsc@hku.hk. 3. 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: yfwan@hku.hk. 4. 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: sarahmcghee7@gmail.com. 5. 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: carlosho@hku.hk. 6. 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: ddai@ha.org.hk. 7. 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: kwoklp@ha.org.hk. 8. 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: clklam@hku.hk.
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. Copyright Â
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. Copyright Â
Authors: Fangfang Jiao; Eric Yuk Fai Wan; Colman Siu Cheung Fung; Anca Ka Chun Chan; Sarah Morag McGhee; Ruby Lai Ping Kwok; Cindy Lo Kuen Lam Journal: Endocrine Date: 2018-08-28 Impact factor: 3.633