Effects of structured versus usual care on renal endpoint in type 2 diabetes: the SURE study: a randomized multicenter translational study.
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.


METHODS
A total of 205 Chinese type 2 diabetic patients from nine public hospitals who had plasma creatinine levels of 150-350 micromol/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 micromol/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 >or=3 treatment goals (61%, n = 63, vs. 28%, n = 28; P < 0.001). Patients who attained >or=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 <or=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.
Chan
Juliana C
JC
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China. jchan@cuhk.edu.hk
So
Wing-Yee
WY
Yeung
Chun-Yip
CY
Ko
Gary T
GT
Lau
Ip-Tim
IT
Tsang
Man-Wo
MW
Lau
Kam-Piu
KP
Siu
Sing-Chung
SC
Li
June K
JK
Yeung
Vincent T
VT
Leung
Wilson Y
WY
Tong
Peter C
PC
D000328:Adult; D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D010348:Patient Care Team; D017582:Renal Replacement Therapy / Q000379:methods; D012306:Risk; D013997:Time Factors; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
D008078:Cholesterol, LDL; D003404:Creatinine; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D014280:Triglycerides