Effects of Structured Versus Usual Care on Renal Endpoint in Type 2 Diabetes: The SURE Study: A randomized multicenter translational study

• Published in: Diabetes care Vol. 32; no. 6; pp. 977 - 982
• Main Authors: Chan, Juliana C, So, Wing-Yee, Yeung, Chun-Yip, Ko, Gary T, Lau, Ip-Tim, Tsang, Man-Wo, Lau, Kam-Piu, Siu, Sing-Chung, Li, June K, Yeung, Vincent T, Leung, Wilson Y, Tong, Peter C
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.06.2009
• Subjects: ACE inhibitors; Adult; Aged; Analysis; Biological and medical sciences; Blood pressure; Cholesterol; Cholesterol, LDL - blood; Compliance; Creatinine - blood; Diabetes; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - mortality; Diabetes Mellitus, Type 2 - physiopathology; Diabetes therapy; Diabetes. Impaired glucose tolerance; Diabetic Nephropathies - epidemiology; Diabetic Nephropathies - mortality; Diabetic Nephropathies - prevention & control; Disease; Drug use; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Glycated Hemoglobin A - analysis; Health aspects; Health services; Hospitalization; Hospitals; Humans; Hypoglycemic Agents - therapeutic use; Integrated approach; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - therapy; Kidneys; Low density lipoproteins; Medical sciences; Metabolic diseases; Middle Aged; Miscellaneous; Monitoring, Physiologic - methods; Mortality; Original Research; Patient Care Team; Plasma; Public health. Hygiene; Public health. Hygiene-occupational medicine; Renal Replacement Therapy - methods; Risk; Risk factors; Substance abuse treatment; Time Factors; Trans fatty acids; Treatment Outcome; Triglycerides - blood; Type 2 diabetes; China; Endocrinopathy; Type 2 diabetes; Human; Nutrition; Multicenter study; Metabolic diseases; Genetic translation; Kidney; Care; Randomization; Urinary system; Endocrinology; Comparative study
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc08-1908

OBJECTIVE: Multifaceted care has been shown to reduce mortality and complications in type 2 diabetes. We hypothesized that structured care would reduce renal complications in type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 205 Chinese type 2 diabetic patients from nine public hospitals who had plasma creatinine levels of 150-350 μmol/l were randomly assigned to receive structured care (n = 104) or usual care (n = 101) for 2 years. The structured care group was managed according to a prespecified protocol with the following treatment goals: blood pressure <130/80 mmHg, A1C <7%, LDL cholesterol <2.6 mmol/l, triglyceride <2 mmol/l, and persistent treatment with renin-angiotensin blockers. The primary end point was death and/or renal end point (creatinine >500 μmol/l or dialysis). RESULTS: Of these 205 patients (mean ± SD age 65 ± 7.2 years; disease duration 14 ± 7.9 years), the structured care group achieved better control than the usual care group (diastolic blood pressure 68 ± 12 vs. 71 ± 12 mmHg, respectively, P = 0.02; A1C 7.3 ± 1.3 vs. 8.0 ± 1.6%, P < 0.01). After adjustment for age, sex, and study sites, the structured care (23.1%, n = 24) and usual care (23.8%, n = 24; NS) groups had similar end points, but more patients in the structured care group attained greater-than-or-equal3 treatment goals (61%, n = 63, vs. 28%, n = 28; P < 0.001). Patients who attained greater-than-or-equal3 treatment targets (n = 91) had reduced risk of the primary end point (14 vs. 34; relative risk 0.43 [95% CI 0.21-0.86] compared with that of those who attained [less-than or equal to]2 targets (n = 114). CONCLUSIONS: Attainment of multiple treatment targets reduced the renal end point and death in type 2 diabetes. In addition to protocol, audits and feedback are needed to improve outcomes.