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- Publisher Website: 10.2337/dc22-0387
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Article: Ten-Year Effectiveness of the Multidisciplinary Risk Assessment and Management Programme–Diabetes Mellitus (RAMP-DM) on Macrovascular and Microvascular Complications and All-Cause Mortality: A Population-Based Cohort Study
Title | Ten-Year Effectiveness of the Multidisciplinary Risk Assessment and Management Programme–Diabetes Mellitus (RAMP-DM) on Macrovascular and Microvascular Complications and All-Cause Mortality: A Population-Based Cohort Study |
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Authors | |
Issue Date | 2022 |
Citation | Diabetes Care, 2022 How to Cite? |
Abstract | OBJECTIVE The Risk Assessment and Management Programme–Diabetes Mellitus (RAMP-DM) is a protocol-driven, risk-stratified, and individualized management program offered by a multidisciplinary team in addition to usual care for primary care patients with diabetes. This study aimed to evaluate the effectiveness of RAMP-DM for preventing complications and mortality over 10 years. RESEARCH DESIGN AND METHODS A population-based, prospective cohort study of adult patients with type 2 diabetes managed in the Hong Kong public primary health care system between 2009 and 2010 was conducted. RAMP-DM participants and usual care patients were matched using one-to-one propensity score matching and followed for 10 years. Risks of macrovascular and microvascular complications and all-cause mortality were estimated by Cox proportional hazards regression. RESULTS A total of 36,746 patients (18,373 in each group) were included after propensity score matching, with a median follow-up of 9.5 years and 306,802 person-years. RAMP-DM participants had significantly lower risks of macrovascular (hazard ratio [HR] 0.52, 95% CI 0.50–0.54) and microvascular (HR 0.68, 95% CI 0.64–0.72) complications and all-cause mortality (HR 0.45, 95% CI 0.43–0.47) than patients who received usual care only. However, the effect of RAMP-DM on macrovascular and microvascular complications attenuated after the 9th and 8th year of follow-up, respectively. RAMP-DM participants also showed better control of hemoglobin A1c, blood pressure, triglycerides, and BMI and a slower decline in renal function. CONCLUSIONS Significant reductions in diabetes-related complications and all-cause mortality were observed among RAMP-DM participants over a 10-year follow-up, yet the effect of preventing complications attenuated after 8 years. |
Persistent Identifier | http://hdl.handle.net/10722/315598 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Tang, HM | - |
dc.contributor.author | Mak, IL | - |
dc.contributor.author | Tse, TYE | - |
dc.contributor.author | Wan, YFE | - |
dc.contributor.author | Yu, YTE | - |
dc.contributor.author | Chen, JY | - |
dc.contributor.author | Chin, WY | - |
dc.contributor.author | Chao, VKD | - |
dc.contributor.author | Tsui, WSW | - |
dc.contributor.author | Ha, TKH | - |
dc.contributor.author | Wong, CKH | - |
dc.contributor.author | Lam, CLK | - |
dc.date.accessioned | 2022-08-19T09:00:52Z | - |
dc.date.available | 2022-08-19T09:00:52Z | - |
dc.date.issued | 2022 | - |
dc.identifier.citation | Diabetes Care, 2022 | - |
dc.identifier.uri | http://hdl.handle.net/10722/315598 | - |
dc.description.abstract | OBJECTIVE The Risk Assessment and Management Programme–Diabetes Mellitus (RAMP-DM) is a protocol-driven, risk-stratified, and individualized management program offered by a multidisciplinary team in addition to usual care for primary care patients with diabetes. This study aimed to evaluate the effectiveness of RAMP-DM for preventing complications and mortality over 10 years. RESEARCH DESIGN AND METHODS A population-based, prospective cohort study of adult patients with type 2 diabetes managed in the Hong Kong public primary health care system between 2009 and 2010 was conducted. RAMP-DM participants and usual care patients were matched using one-to-one propensity score matching and followed for 10 years. Risks of macrovascular and microvascular complications and all-cause mortality were estimated by Cox proportional hazards regression. RESULTS A total of 36,746 patients (18,373 in each group) were included after propensity score matching, with a median follow-up of 9.5 years and 306,802 person-years. RAMP-DM participants had significantly lower risks of macrovascular (hazard ratio [HR] 0.52, 95% CI 0.50–0.54) and microvascular (HR 0.68, 95% CI 0.64–0.72) complications and all-cause mortality (HR 0.45, 95% CI 0.43–0.47) than patients who received usual care only. However, the effect of RAMP-DM on macrovascular and microvascular complications attenuated after the 9th and 8th year of follow-up, respectively. RAMP-DM participants also showed better control of hemoglobin A1c, blood pressure, triglycerides, and BMI and a slower decline in renal function. CONCLUSIONS Significant reductions in diabetes-related complications and all-cause mortality were observed among RAMP-DM participants over a 10-year follow-up, yet the effect of preventing complications attenuated after 8 years. | - |
dc.language | eng | - |
dc.relation.ispartof | Diabetes Care | - |
dc.title | Ten-Year Effectiveness of the Multidisciplinary Risk Assessment and Management Programme–Diabetes Mellitus (RAMP-DM) on Macrovascular and Microvascular Complications and All-Cause Mortality: A Population-Based Cohort Study | - |
dc.type | Article | - |
dc.identifier.email | Tang, HM: erichm@hku.hk | - |
dc.identifier.email | Mak, IL: ilmak@hku.hk | - |
dc.identifier.email | Tse, TYE: emilyht@hku.hk | - |
dc.identifier.email | Wan, YFE: yfwan@hku.hk | - |
dc.identifier.email | Yu, YTE: ytyu@hku.hk | - |
dc.identifier.email | Chen, JY: juliechen@hku.hk | - |
dc.identifier.email | Chin, WY: chinwy@hku.hk | - |
dc.identifier.email | Chao, VKD: dchku001@hku.hk | - |
dc.identifier.email | Tsui, WSW: tsuiws1@hku.hk | - |
dc.identifier.email | Wong, CKH: carlosho@hku.hk | - |
dc.identifier.email | Lam, CLK: clklam@hku.hk | - |
dc.identifier.authority | Tse, TYE=rp02382 | - |
dc.identifier.authority | Wan, YFE=rp02518 | - |
dc.identifier.authority | Yu, YTE=rp01693 | - |
dc.identifier.authority | Chen, JY=rp00526 | - |
dc.identifier.authority | Chin, WY=rp00290 | - |
dc.identifier.authority | Wong, CKH=rp01931 | - |
dc.identifier.authority | Lam, CLK=rp00350 | - |
dc.identifier.doi | 10.2337/dc22-0387 | - |
dc.identifier.hkuros | 336120 | - |
dc.identifier.isi | WOS:000905200400024 | - |