DKD causes co-morbidities made preventable by attaining multiple targets. Patient empowerment, regular feedback and team-based care assisted by JADE Technology with risk stratification and decision support may improve targets attainment and clinical outcomes. In 2014-2018, 2435 patients1 with DKD2 (age:67.6±9.9 years, DM duration:16.5±9.7 years; BMI:26.9±4.7 kg/m2; A1c:7.9±1.6%; SBP:139±18 mmHg; LDL-C:2.35±1.05 mmol/L; TG:1.92±1.29 mmol/L; RASi:70.0%; statin:74.8%; CVD:32.0%, cancer:5.0%, heart failure:3.9%, ≥3 targets3:33.6%), were randomized to usual care (UC=809), empowered care (EC=819) and team-based empowered care (TEC=807) for 1 year with endpoints defined at year 1 and when study ends. After structured assessment, EC and TEC received JADE report, with EC receiving 3-monthly phone calls by nurses and TEC, additional 3-monthly review by a doctor-nurse team with JADE follow-up reports. Amongst 1837 returnees at 1 year, TEC had the lowest HbA1c and LDL-C and highest proportion with ≥3 targets (TMT)4. Non-returnees had worse risk profiles and were less likely to have familial DM and received prior DM education. At study end (2019)5, TMT group (27/408) had fewer CV-renal-cancer endpoints than non-TMT group (66/676) with RR of 0.678 (95% CI: 0.668-0.687). Empowerment, information support and continuing team-based care improve risk factor control and clinical outcomes in DKD.

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Disclosure

J.C.N. Chan: Board Member; Self; Asia Diabetes Foundation. Consultant; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Medtronic, Merck Sharp & Dohme Corp., Sanofi-Aventis. Research Support; Self; Amgen Inc., AstraZeneca, Lee Powder, Lilly Diabetes, Pfizer Inc., Sanofi-Aventis. Speaker’s Bureau; Self; Ascensia Diabetes Care. Stock/Shareholder; Self; GemVCare. K.T. Nguyen: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Speaker’s Bureau; Self; Abbott. Other Relationship; Self; AstraZeneca, Novo Nordisk A/S, Sanofi-Aventis. A. Tan: None. Y.C. Chia: None. C. Hwu: None. E. Hong: None. Y. Thewjitcharoen: None. J. Du: None. S. Yoo: None. R.C. Mirasol: None. E.S. Lau: None. V. Lau: None. A.W.C. Fu: None. M. Mohamed: None. K. Yoon: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novo Nordisk Inc. Speaker’s Bureau; Self; Takeda Pharmaceutical Company Limited. C. Tsang: None. A. Luk: None.

Funding

Asia Diabetes Foundation

© 2019 by the American Diabetes Association.
2019
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