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

• Published in: Diabetes care Vol. 45; no. 12; pp. 2871 - 2882
• Main Authors: Tang, Eric Ho Man, Mak, Ivy Lynn, Tse, Emily Tsui Yee, Wan, Eric Yuk Fai, Yu, Esther Yee Tak, Chen, Julie Yun, Chin, Weng Yee, Chao, David Vai Kiong, Tsui, Wendy Wing Sze, Ha, Tony King Hang, Wong, Carlos King Ho, Lam, Cindy Lo Kuen
• Format: Journal Article
• Language: English
• Published: United States American Diabetes Association 01.12.2022
• Subjects: Adult; Blood pressure; Cohort analysis; Cohort Studies; Complications; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Effectiveness; Health care; Health hazards; Hemoglobin; Humans; Matching; Microvasculature; Mortality; Patients; Population studies; Population-based studies; Primary care; Primary Health Care; Prospective Studies; Renal function; Research design; Risk Assessment; Risk Factors; Risk management; Triglycerides
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc22-0387

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. 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. 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. 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.