Evolution of Diabetes Mellitus Care in Hong Kong Public Primary Care Setting: Changes after 10-year Implementation of Risk Assessment and Management Program in Diabetes Mellitus (RAMP-DM).

Abstract

This study aims to evaluate the changes in clinical profiles, complications, and treatment modalities of people with diabetes after a decade of implementing the multidisciplinary Risk Assessment and Management Program in DM (RAMP-DM). A two-phase cross-sectional study was conducted to examine the evolution of care for people with diabetes in 13 public primary care clinics from 1 August 2008 to 31 July 2009 and 1 August 2019 to 31 July 2020. The average systolic blood pressure (SBP) improved from 131.66±16.89 to 126.88±12.54 mmHg (P<0.001). Hemoglobin A1c (HbA1c) and low-density lipoprotein concentration (LDL-C) improved from 7.47±1.4 to 6.88±1.00% (P<0.001) and 3.09±0.85 to 2.01±0.68 mmol/L (P<0.001), respectively. However, the percentage of patients with ischemic heart disease (IHD) rose from 7.73% to 10.47% (P<0.001), and stroke increased from 8.22% to 12.44% (P<0.001) over the decade. This is the first study to demonstrate the improvement of clinical parameters and treatment modalities of diabetes care in a public primary care setting over a decade. The increasing prevalence of IHD and stroke may be related to the aging population and the decreasing trend of all-cause mortality among people with diabetes.