Effectiveness of a multidisciplinary risk assessment and management program for patients with diabetes (RAMP-DM) in preventing diabetic complications: three-year follow-up of a prospective propensity score matched comparative study

Abstract

Aims: To evaluate the effectiveness of a Multidisciplinary Risk Assessment and Management Program for patients with diabetes (RAMP-DM) in reducing the risks of various diabetic complications and all-cause mortality. Methods: A prospective cohort study was conducted in 9,094 propensity score matched pairs of RAMP-DM participants and diabetic subjects under usual primary care. We constructed multivariable Cox proportional hazard regressions to estimate the association between the RAMP-DM intervention and various diabetic complications and all-cause mortality. Results: Over a median of 36 months follow-up, the RAMP-DM group had a lower incidence of all the study endpoints. The adjusted hazard ratios of the RAMP-DM group for coronary heart disease (CHD), stroke, heart failure (HF), total cardiovascular disease (CVD), end stage renal disease (ESRD), diabetic retinopathy (DR) and sight threatening diabetic retinopathy (STDR) and all-cause mortality were 0.570, 0.652, 0.598, 0.629, 0.674 , 0.836 ,0.578 and 0.363, respectively (P<0.05 for all). Conclusions: The RAMP-DM intervention was associated with lower risks of various diabetic complications and all-cause mortality over three years follow-up. The encouraging results provided evidence to support that the structured risk stratification management leading by a multidisciplinary clinical team was an effective approach to reduce future complications in people with diabetes.