Effect of a Web-Based Management Guide on Risk Factors in Patients With Type 2 Diabetes and Diabetic Kidney Disease
Authors: Juliana C. N. Chan, Yotsapon Thewjitcharoen, Thy Khue Nguyen, Alexander Tan, Yook-Chin Chia, Chii-Min Hwu, Du Jian, Thep Himathongkam, Kim-Leng Wong, Yun-Mi Choi, Roberto Mirasol, Mafauzy Mohamed, Alice P. S. Kong, Ronald C. W. Ma, Elaine Y. K. Chow, Risa Ozaki, Vanessa Lau, Amy W. C. Fu, Eun-Gyoung Hong, Kun-Ho Yoon, Chiu-Chi Tsang, Eric S. H. Lau, Lee-Ling Lim, Andrea O. Y. Luk
Journal: JAMA Network Open (2022)

<h3>Importance</h3> Diabetic kidney disease (DKD) and its comorbidities can be prevented by treating multiple targets. Technology-assisted team-based care with regular feedback and patient empowerment can improve the attainment of multiple targets and clinical outcomes in patients with type 2 diabetes, but the effects of this intervention on patients with DKD are unclear. <h3>Objective</h3> To evaluate the effect of the Joint Asia Diabetes Evaluation (JADE) web portal, nurse reminders, and team-based care on multiple risk factors in patients with DKD. <h3>Design, Setting, and Participants</h3> This 12-month multinational, open-label randomized clinical trial was conducted between June 27, 2014, and February 19, 2019, at 13 hospital-based diabetes centers in 8 countries or regions in Asia. All patients who participated had DKD. The intention-to-treat data analysis was performed from April 7 to June 30, 2020. <h3>Interventions</h3> Patients were randomized in a 1:1:1 ratio at each site to usual care, empowered care, or team-based empowered care. All patients underwent a JADE web portal–guided structured assessment at baseline and month 12. Patients in the usual care and empowered care groups received a medical follow-up. Patients in the empowered care group also received a personalized JADE report and nurse telephone calls every 3 months. Patients in the team-based empowered care group received additional face-to-face reviews every 3 months from a physician-nurse team. <h3>Main Outcomes and Measures</h3> The primary outcome was the proportion of patients who attained multiple treatment targets (defined as ≥3 of 5 targets: HbA<sub>1c</sub>level &lt;7.0% [53 mmol/mol], blood pressure &lt;130/80 mm Hg, low-density lipoprotein cholesterol level &lt;1.8 mmol/L, triglyceride level &lt;1.7 mmol/L, and/or persistent use of renin-angiotensin-aldosterone system inhibitors). <h3>Results</h3> A total of 2393 patients (mean [SD] age, 67.7 [9.8] years; 1267 men [52.9%]) were randomized to the usual care group (n = 795), empowered care group (n = 802), and team-based empowered care group (n = 796). At baseline, 34.7% patients (n = 830) were on 3 treatment targets. On intention-to-treat analysis, the team-based empowered care group had the highest proportion of patients who had further increase in attainment of multiple treatment targets (within-group differences: usual care group, 3.9% [95% CI, 0.0%-7.8%]; empowered care group, 1.3% [95% CI, −2.8% to 5.4%]; team-based empowered care group, 9.1% [95% CI, 4.7%-13.5%]). The team-based empowered care group was more likely to attain multiple treatment targets than the usual care group (risk ratio [RR], 1.17; 95% CI, 1.00-1.37) and the empowered care group (RR, 1.25; 95% CI, 1.06-1.48) after adjustment for site. Compared with the group that did not attain multiple treatment targets, the group that attained multiple treatment targets reported a lower incidence of cardiovascular, kidney, and cancer events (8.4% [n = 51] vs 14.5% [n = 134];<i>P</i> = .004). Analysis of the per-protocol population yielded similar results. <h3>Conclusions and Relevance</h3> This trial found that technology-assisted team-based care for 12 months improved the attainment of multiple treatment targets as well as empowerment in patients with DKD. <h3>Trial Registration</h3> ClinicalTrials.gov Identifier:NCT02176278