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

doi:10.1016/j.diabet.2016.07.030

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

Diabetes Metab. 2016 Dec;42(6):424-432. doi: 10.1016/j.diabet.2016.07.030. Epub 2016 Aug 24.

Authors

F Jiao¹, C S C Fung², Y F Wan³, S M McGhee⁴, C K H Wong⁵, D Dai⁶, R Kwok⁷, C L K Lam⁸

Affiliations

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.

PMID: 27568125
DOI: 10.1016/j.diabet.2016.07.030

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.

Keywords: Diabetes mellitus; Microvascular complications; Multidisciplinary; Risk stratification.

Publication types

Clinical Trial

MeSH terms

Aged
Diabetic Angiopathies* / epidemiology
Diabetic Angiopathies* / prevention & control
Diabetic Angiopathies* / therapy
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Prospective Studies
Risk Assessment

Associated data

ClinicalTrials.gov/NCT02034695