Effects of Structured Versus Usual Care on Renal Endpoint in Type 2 Diabetes: The SURE Study
A randomized multicenter translational study
- Juliana C. Chan, MD1,
- Wing-Yee So, FRCP1,
- Chun-Yip Yeung, MRCP1,
- Gary T. Ko, MD2,
- Ip-Tim Lau, FRCP3,
- Man-Wo Tsang, FRCP4,
- Kam-Piu Lau, FRCP5,
- Sing-Chung Siu, FRCP6,
- June K. Li, FRCP7,
- Vincent T. Yeung, MD8,
- Wilson Y. Leung, PHD1,
- Peter C. Tong, PHD1 and
- for the SURE Study Group*
- 1Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China;
- 2Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China;
- 3Tseung Kwan O Hospital, Hong Kong SAR, China;
- 4United Christian Hospital, Hong Kong SAR, China;
- 5North District Hospital, Hong Kong SAR, China;
- 6Tung Wah Eastern Diabetes Center, Hong Kong SAR, China;
- 7Yan Chai Hospital, Hong Kong SAR, China;
- 8Our Lady of Maryknoll Hospital, Hong Kong SAR, China.
- Corresponding author: Juliana C. Chan, jchan{at}cuhk.edu.hk.
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 <130/80 mmHg, A1C <7%, LDL cholesterol <2.6 mmol/l, triglyceride <2 mmol/l, and persistent treatment with renin-angiotensin blockers. The primary end point was death and/or renal end point (creatinine >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.
Footnotes
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↵*Other members of the SURE Study Group are listed in the appendix.
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The sponsors did not have any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
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Clinical trial reg. no. NCT00309127, clinicaltrials.gov.
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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See accompanying editorial, p. 1132.
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- Received October 21, 2008.
- Accepted January 26, 2009.
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Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
- © 2009 by the American Diabetes Association.
