1. Effects of structured versus usual care on renal endpoint in type 2 diabetes: the SURE study: a randomized multicenter translational study
- Author
-
Juliana C, Chan, Wing-Yee, So, Chun-Yip, Yeung, Gary T, Ko, Ip-Tim, Lau, Man-Wo, Tsang, Kam-Piu, Lau, Sing-Chung, Siu, June K, Li, Vincent T, Yeung, Wilson Y, Leung, Peter C, Tong, and Tai-Pan, Ip
- Subjects
Adult ,Risk ,medicine.medical_specialty ,Time Factors ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Type 2 diabetes ,law.invention ,Randomized controlled trial ,law ,Internal medicine ,Diabetes mellitus ,Internal Medicine ,Clinical endpoint ,medicine ,Humans ,Hypoglycemic Agents ,Diabetic Nephropathies ,Renal replacement therapy ,Triglycerides ,Original Research ,Aged ,Monitoring, Physiologic ,Advanced and Specialized Nursing ,Glycated Hemoglobin ,Patient Care Team ,business.industry ,Clinical Care/Education/Nutrition/Psychosocial Research ,Editorials ,Cholesterol, LDL ,Middle Aged ,medicine.disease ,Genetic translation ,Surgery ,Renal Replacement Therapy ,Blood pressure ,Treatment Outcome ,Editorial ,Diabetes Mellitus, Type 2 ,Relative risk ,Creatinine ,Kidney Failure, Chronic ,business - Abstract
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 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 ≥3 treatment goals (61%, n = 63, vs. 28%, n = 28; P < 0.001). Patients who attained ≥3 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 ≤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.
- Published
- 2009