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Long-term effects of the multidisciplinary risk assessment and management program for patients with diabetes mellitus
Fangfang Jiao1, Colman Siu Cheung Fung2, Yuk Fai Wan3
1Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong. francesj@connect.hku.hk.
Insights
A multidisciplinary risk assessment and management program for diabetes mellitus (RAMP-DM) significantly reduced cardiovascular complications and all-cause mortality in Chinese patients over three years.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Limited data on long-term effectiveness of multidisciplinary risk-stratification management for diabetes in China.
- Cardiovascular complications and mortality are major concerns for diabetic patients.
Purpose of the Study:
- To evaluate the effectiveness of a multidisciplinary risk assessment and management program for diabetes mellitus (RAMP-DM).
- To assess the program's impact on reducing cardiovascular complications and all-cause mortality in a Chinese population.
Main Methods:
- Prospective cohort study involving 18,188 propensity score-matched participants.
- Comparison between RAMP-DM participants and patients receiving usual primary care.
- Analysis of endpoints including coronary heart disease (CHD), stroke, heart failure (HF), total cardiovascular disease (CVD), and all-cause mortality using Cox regression.
Main Results:
- A significant reduction in CVD events (adjusted hazard ratio [aHR], 0.629; P < 0.001) and all-cause mortality (aHR, 0.363; P < 0.001) in the RAMP-DM group over 36 months.
- Lower incidences of CHD (aHR, 0.570; P < 0.001), stroke (aHR, 0.652; P < 0.001), and HF (aHR, 0.598; P = 0.001) were observed in the RAMP-DM group.
- RAMP-DM participants experienced less than half the all-cause deaths compared to the control group.
Conclusions:
- The RAMP-DM intervention effectively lowered the incidence of cardiovascular complications and all-cause mortality in diabetic patients.
- Structured, multidisciplinary, risk-stratification management is a viable strategy for mitigating future cardiovascular risks in diabetes.
Background:
Studies on the long-term effectiveness of multidisciplinary risk-stratification based management in Chinese population were rare. This study aimed to evaluate the effectiveness of a multidisciplinary risk assessment and management program for patients with diabetes mellitus (RAMP-DM) in reducing the risks of cardiovascular complications and all-cause mortality.
Methods:
A prospective cohort study was conducted in 18,188 propensity score matched RAMP-DM participants and subjects with diabetes under usual primary care (9,094 subjects in each group). The study endpoints were the first occurrence of coronary heart disease (CHD), stroke, heart failure (HF), total cardiovascular disease (CVD) and all-cause mortality. We constructed multivariable Cox proportional hazard regressions to estimate the association between the RAMP-DM intervention and the first occurrence of study endpoints.
Results:
The median follow-up period was 36 months. Three hundred and ninety-nine CVD events occurred in the RAMP-DM group, as compared with 608 in the control group [adjusted hazard ratio, 0.629; 95% confidence interval (CI) 0.554-0.715; P < 0.001]. The total number of all-cause deaths in RAMP-DM group was less than half that of control group (202 vs 552, adjusted hazard ratio, 0.363; 95% CI, 0.308-0.428; P < 0.001). The adjusted hazard ratios of the RAMP-DM group for CHD, stroke, and HF were 0.570 (95% CI, 0.470-0.691; P < 0.001), 0.652 (95% CI, 0.546-0.780; P < 0.001), and 0.598 (95%CI, 0.446-0.802; P = 0.001), respectively.
Conclusions:
The RAMP-DM intervention was associated with lower incidences of individual and total cardiovascular complications, as well as all-cause mortality over 3 years follow-up. The encouraging results provided evidence to support that the structured risk-stratification management leading by a multidisciplinary clinical team was an effective approach to reduce future cardiovascular complications in people with diabetes.
Clinical Trial Registry:
NCT02034695, http://www.ClinicalTrials.gov.
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