Five-Year Effectiveness of the Multidisciplinary Risk Assessment and Management Programme–Diabetes Mellitus (RAMP-DM) on Diabetes-Related Complications and Health Service Uses—A Population-Based and Propensity-Matched Cohort Study

Abstract

OBJECTIVE To evaluate the 5-year effectiveness of a multidisciplinary Risk Assessment and Management Program for primary care patients with type 2 Diabetes Mellitus (RAMP-DM)‎. RESEARCH DESIGN AND METHODS A 5-year prospective cohort study was conducted with 121,584 Chinese primary care patients with type 2 DM who were recruited between August 2009 and June 2011. Missing data were dealt with multiple imputations. After excluding patients with prior DM-related complications and one-to-one propensity score matching on all patient characteristics, 26,718 RAMP-DM participants and 26,718 matched usual-care patients were followed up for a median time of 4.5 years. The effect of RAMP-DM on nine DM-related complications and all-cause mortality were evaluated using Cox regressions. The first incidence for each event was used for all models. Health service use was analyzed using negative binomial regressions. Subgroup analyses on different patient characteristics were performed. RESULTS The cumulative incidence of all events (DM-related complications and all-cause mortality) was 23.2% in the RAMP-DM group and 43.6% in the usual-care group. RAMP-DM led to significantly greater reductions in cardiovascular disease (CVD) risk by 56.6% (95% CI 54.5, 58.6%); microvascular complications by 11.9% (95% CI 7.0, 16.6%); mortality by 66.1% (95% CI 64.3, 67.9%); specialist attendance by 35.0% (95% CI 33.6, 36.4%); emergency attendance by 41.2% (95% CI 39.8, 42.5%); and hospitalizations by 58.5% (95% CI 57.2, 59.7%). Patients with low baseline CVD risks benefitted the most from RAMP-DM, which decreased CVD and mortality risk by 60.4% (95% CI 51.8, 67.5%) and 83.6% (95% CI 79.3, 87.0%), respectively. CONCLUSIONS This naturalistic study highlighted the importance of early optimal DM control and risk factor management by risk stratification and multidisciplinary, protocol-driven, chronic disease model care to delay disease progression and prevent complications.