10yr_RAMP-DM_effectiveness_Online-only_supplemental_material.pdf (872.78 kB)

Ten-year effectiveness of multidisciplinary Risk Assessment and Management Programme - Diabetes Mellitus (RAMP-DM) on macrovascular, microvascular complications and all-cause mortality: A population-based cohort study

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posted on 2022-08-12, 15:43 authored by Eric Ho Man Tang, Ivy Lynn Mak, Emily Tsui Yee Tse, Eric Yuk Fai Wan, Esther Yee Tak Yu, Julie Yun Chen, Weng Yee Chin, David Vai Kiong Chao, Wendy Wing Sze Tsui, Tony King Hang Ha, Carlos King Ho Wong, Cindy Lo Kuen Lam

Objective

The Risk Assessment and Management Programme – Diabetes Mellitus (RAMP-DM) is a protocol-driven, risk-stratified, and individualised management programme, offered by a multidisciplinary team in addition to usual care for primary care patients with diabetes mellitus. This study aims to evaluate the effectiveness of RAMP-DM for preventing complications and mortality over ten 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 healthcare system between 2009 and 2010 was conducted. RAMP-DM participants and usual care patients were matched with one-to-one propensity score matching, and followed for ten years. Risks of macrovascular, microvascular complications and all-cause mortality were estimated by Cox proportional hazard regressions.

Results

A total of 36,746 patients (18,373 in each group) were included after propensity score matching, with median follow-up of 9.5 years and 306,802 person-years. RAMP-DM participants had significantly lower risks of macrovascular (HR=0.52, 95%CI: 0.50-0.54), microvascular complications (HR=0.68, 95%CI: 0.64-0.72) and all-cause mortality (HR=0.45, 95%CI: 0.43-0.47) than patients received usual care only. However, the effect of RAMP-DM on macrovascular and microvascular complications attenuated after ninth and eighth year of follow-up, respectively. RAMP-DM participants also showed better control in haemoglobin A1c, blood pressures, triglycerides and body mass index, 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 ten-year follow-up, yet the effect of preventing complications were seen to attenuate after eight years.