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
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.
