Department of Family Medicine and Primary Care, Ap Lei Chau Clinic, Ap Lei Chau, The University of Hong Kong, Hong Kong, People's Republic of China
Department of Family Medicine and Primary Care, Ap Lei Chau Clinic, Ap Lei Chau, The University of Hong Kong, Hong Kong, People's Republic of China.
Diabetes Care. 2018 Jan;41(1):49-59. doi: 10.2337/dc17-0426. Epub 2017 Nov 14.
To evaluate the 5-year effectiveness of a multidisciplinary Risk Assessment and Management Programme-Diabetes Mellitus (RAMP-DM) in primary care patients with type 2 diabetes.
A 5-year prospective cohort study was conducted with 121,584 Chinese primary care patients with type 2 DM who were recruited between August 2009 and June 2011. Missing data were dealt with multiple imputations. After excluding patients with prior diabetes mellitus (DM)-related complications and one-to-one propensity score matching on all patient characteristics, 26,718 RAMP-DM participants and 26,718 matched usual care patients were followed up for a median time of 4.5 years. The effect of RAMP-DM on nine DM-related complications and all-cause mortality were evaluated using Cox regressions. The first incidence for each event was used for all models. Health service use was analyzed using negative binomial regressions. Subgroup analyses on different patient characteristics were performed.
The cumulative incidence of all events (DM-related complications and all-cause mortality) was 23.2% in the RAMP-DM group and 43.6% in the usual care group. RAMP-DM led to significantly greater reductions in cardiovascular disease (CVD) risk by 56.6% (95% CI 54.5, 58.6), microvascular complications by 11.9% (95% CI 7.0, 16.6), mortality by 66.1% (95% CI 64.3, 67.9), specialist attendance by 35.0% (95% CI 33.6, 36.4), emergency attendance by 41.2% (95% CI 39.8, 42.5), and hospitalizations by 58.5% (95% CI 57.2, 59.7). Patients with low baseline CVD risks benefitted the most from RAMP-DM, which decreased CVD and mortality risk by 60.4% (95% CI 51.8, 67.5) and 83.6% (95% CI 79.3, 87.0), respectively.
This naturalistic study highlighted the importance of early optimal DM control and risk factor management by risk stratification and multidisciplinary, protocol-driven, chronic disease model care to delay disease progression and prevent complications.
评估多学科风险评估和管理计划-糖尿病（RAMP-DM）在基层医疗 2 型糖尿病患者中的 5 年效果。
这是一项前瞻性队列研究，纳入了 2009 年 8 月至 2011 年 6 月期间招募的 121584 名中国基层医疗 2 型糖尿病患者。对于缺失数据，采用多重插补法进行处理。在排除有糖尿病相关并发症史的患者以及对所有患者特征进行一对一倾向评分匹配后，对 26718 名 RAMP-DM 参与者和 26718 名匹配的常规护理患者进行了中位时间为 4.5 年的随访。使用 Cox 回归评估 RAMP-DM 对 9 种糖尿病相关并发症和全因死亡率的影响。所有模型均采用首次发生的事件作为因变量。采用负二项回归分析卫生服务利用情况。对不同患者特征进行亚组分析。
RAMP-DM 组的全因事件（糖尿病相关并发症和全因死亡率）累积发生率为 23.2%，常规护理组为 43.6%。RAMP-DM 可显著降低心血管疾病（CVD）风险 56.6%（95%CI 54.5，58.6）、微血管并发症 11.9%（95%CI 7.0，16.6）、死亡率 66.1%（95%CI 64.3，67.9）、专科就诊率 35.0%（95%CI 33.6，36.4）、急诊就诊率 41.2%（95%CI 39.8，42.5）和住院率 58.5%（95%CI 57.2，59.7）。基线 CVD 风险较低的患者从 RAMP-DM 中获益最大，可降低 CVD 和死亡率风险分别达 60.4%（95%CI 51.8，67.5）和 83.6%（95%CI 79.3，87.0）。
本项自然主义研究强调了通过风险分层和多学科、基于协议的慢性病管理模式进行早期优化糖尿病控制和危险因素管理的重要性，以延缓疾病进展和预防并发症。
