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Article: 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

TitleEffectiveness of the multidisciplinary Risk Assessment and Management Program for Patients with Diabetes Mellitus (RAMP-DM) for diabetic microvascular complications: A population-based cohort study
Authors
Issue Date2016
PublisherElsevier Masson. The Journal's web site is located at http://www.elsevier-masson.fr/diabetes-metabolism-1262-3636.html
Citation
Diabetes & Metabolism, 2016, v. 42 n. 6, p. 424-432 How to Cite?
AbstractAim: 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.
Persistent Identifierhttp://hdl.handle.net/10722/233556
ISSN
2015 Impact Factor: 4.693
2015 SCImago Journal Rankings: 1.252
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorJiao, F-
dc.contributor.authorFung, SCC-
dc.contributor.authorWan, YF-
dc.contributor.authorMcGhee, SM-
dc.contributor.authorWong, CKH-
dc.contributor.authorDai, D-
dc.contributor.authorKwok, RLP-
dc.contributor.authorLam, CLK-
dc.date.accessioned2016-09-20T05:37:35Z-
dc.date.available2016-09-20T05:37:35Z-
dc.date.issued2016-
dc.identifier.citationDiabetes & Metabolism, 2016, v. 42 n. 6, p. 424-432-
dc.identifier.issn1262-3636-
dc.identifier.urihttp://hdl.handle.net/10722/233556-
dc.description.abstractAim: 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.-
dc.languageeng-
dc.publisherElsevier Masson. The Journal's web site is located at http://www.elsevier-masson.fr/diabetes-metabolism-1262-3636.html-
dc.relation.ispartofDiabetes & Metabolism-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.titleEffectiveness of the multidisciplinary Risk Assessment and Management Program for Patients with Diabetes Mellitus (RAMP-DM) for diabetic microvascular complications: A population-based cohort study-
dc.typeArticle-
dc.identifier.emailFung, SCC: cfsc@hku.hk-
dc.identifier.emailWan, YF: yfwan@hku.hk-
dc.identifier.emailMcGhee, SM: smmcghee@hkucc.hku.hk-
dc.identifier.emailWong, CKH: carlosho@hku.hk-
dc.identifier.emailLam, CLK: clklam@hku.hk-
dc.identifier.authorityFung, SCC=rp01330-
dc.identifier.authorityMcGhee, SM=rp00393-
dc.identifier.authorityWong, CKH=rp01931-
dc.identifier.authorityLam, CLK=rp00350-
dc.description.naturepostprint-
dc.identifier.doi10.1016/j.diabet.2016.07.030-
dc.identifier.pmid27568125-
dc.identifier.scopuseid_2-s2.0-84994116134-
dc.identifier.hkuros264825-
dc.identifier.volume42-
dc.identifier.issue6-
dc.identifier.spage424-
dc.identifier.epage432-
dc.identifier.isiWOS:000391903500006-
dc.publisher.placeFrance-

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