Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
Department of Family Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
Diabetes Care. 2022 Dec 1;45(12):2871-2882. 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.
风险评估和管理计划-糖尿病（RAMP-DM）是一种由多学科团队提供的协议驱动、风险分层和个体化管理计划，除了常规护理外，还为初级保健患者提供糖尿病管理。本研究旨在评估 RAMP-DM 在预防 10 年内并发症和死亡率方面的有效性。
对 2009 年至 2010 年间在香港公立初级保健系统中接受管理的成年 2 型糖尿病患者进行了一项基于人群的前瞻性队列研究。使用 1:1 倾向评分匹配将 RAMP-DM 参与者和常规护理患者进行匹配，并随访 10 年。使用 Cox 比例风险回归估计大血管和微血管并发症以及全因死亡率的风险。
在倾向评分匹配后，共有 36746 名患者（每组 18373 名）纳入研究，中位随访时间为 9.5 年，随访总人数为 306802 人。与仅接受常规护理的患者相比，RAMP-DM 参与者的大血管（风险比 [HR] 0.52，95%CI 0.50-0.54）和微血管（HR 0.68，95%CI 0.64-0.72）并发症以及全因死亡率（HR 0.45，95%CI 0.43-0.47）的风险显著降低。然而，RAMP-DM 对大血管和微血管并发症的影响分别在随访第 9 年和第 8 年减弱。RAMP-DM 参与者还显示出更好的血红蛋白 A1c、血压、甘油三酯和 BMI 控制以及肾功能下降速度较慢。
在 10 年的随访中，RAMP-DM 参与者的糖尿病相关并发症和全因死亡率显著降低，但预防并发症的效果在 8 年后减弱。
