PT  - JOURNAL ARTICLE
AU  - Chan, Juliana C.
AU  - So, Wing-Yee
AU  - Yeung, Chun-Yip
AU  - Ko, Gary T.
AU  - Lau, Ip-Tim
AU  - Tsang, Man-Wo
AU  - Lau, Kam-Piu
AU  - Siu, Sing-Chung
AU  - Li, June K.
AU  - Yeung, Vincent T.
AU  - Leung, Wilson Y.
AU  - Tong, Peter C.
AU  - , 
TI  - Effects of Structured Versus Usual Care on Renal Endpoint in Type 2 Diabetes: The SURE Study
AID  - 10.2337/dc08-1908
DP  - 2009 Jun 01
TA  - Diabetes Care
PG  - 977--982
VI  - 32
IP  - 6
4099  - http://care.diabetesjournals.org/content/32/6/977.short
4100  - http://care.diabetesjournals.org/content/32/6/977.full
SO  - Diabetes Care2009 Jun 01; 32
AB  - 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.