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. RESEARCH DESIGN AND METHODS - A total of 205 Chinese type 2 diabetic patients from nine public hospitals who had plasma creatinine levels of 1.50-350 mu mol/l were randomly assigned to receive structured care (n = 1.04) 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 mu mol/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%, 11 = 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% Cl 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. Diabetes Care 32:977-982, 2009