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 - 03/12/16
, C.S.C. Fung a , Y.F. Wan a , S.M. McGhee b , C.K.H. Wong a , D. Dai c , R. Kwok c , C.L.K. Lam a
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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/.
Le texte complet de cet article est disponible en PDF.Keywords : Diabetes mellitus, Microvascular complications, Multidisciplinary, Risk stratification
Abbreviations : DBP, DM, DR, eGFR, ESRD, HR, ICD-9-CM, ICPC-2, NNT, NPDR, RAMP-DM, SBP, STDR
Plan
Vol 42 - N° 6
P. 424-432 - décembre 2016 Retour au numéro
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