Effectiveness of the Multi-disciplinary Risk Assessment and Management Programme (RAMP) on patients with Diabetic Mellitus – the First Year Experience

Abstract

INTRODUCTION: This study aimed to reveal the post 12-month effectiveness of the Multi-disciplinary Risk Assessment and Management Programme (RAMP) on diabetic patients. METHOD: Evaluation involved eleven clinics from four clusters of the Hospital Authority which had started RAMP before June 2010. A random sampling of 1248 patients enrolled into RAMP for more than one year was compared to age-sex, and disease-severity matched non-RAMP controls on clinical outcomes including HbA1c, blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C), and the estimated 10-year cardiovascular disease (CVD) risk using Framingham risk scores equation to reveal the net benefit of RAMP. Independent t-test and Chi-square tests were used for comparison of continuous data and proportions, respectively. RESULTS: Both RAMP and non-RAMP patients showed a reduction in mean HbA1c, blood pressure, and LDL-C; and an increase in proportions of patients achieving target control of HbA1c ≤ 7%, BP ≤ 130/80 mmHg, and LDL-C ≤ 2.6 mmol/L). RAMP group did not show a significant net reduction in HbA1c compared to non-RAMP group but did show a significant net reduction of 2.61 (1.49) mmHg in SBP (DBP), and LDL-C of 0.17 mmol/L. RAMP reduce 10-year CVD risk by 4.66%, which significantly overwhelmed the 2.46% in control group by 2.2%. DISCUSSION: RAMP helped diabetic patients to improve their control of blood glucose, blood pressure, cholesterol level, and reduce their 10-year CVD risk. Significant extra reduction in 10-year CVD risk without net HbA1c reduction supported that the goal of management of diabetic patients should not limited to HbA1c only.