The Joint Asia Diabetes Evaluation (JADE) Program: a web-based program to translate evidence to clinical practice in Type 2 diabetes
The Joint Asia Diabetes Evaluation (JADE) Program: a web-based program to translate evidence to clinical practice in Type 2 diabetes
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DOI：
10.1111/j.1464-5491.2009.02751.x
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发表时间：
2009-07-01
影响因子：
3.5
通讯作者：
Chow, P.
中科院分区：
文献类型：
--
作者：
Chan, J.;So, W.;Chow, P.
亚洲糖尿病联合评估（JADE）项目是首个基于网络的项目，包括综合风险引擎、护理方案、临床决策和自我管理支持，以改善糖尿病的门诊护理。目的是通过一个大型前瞻性队列来验证JADE项目的风险分层系统。方法JADE互动风险引擎根据并发症和危险因素的年度综合评估结果将患者分为不同的风险级别。我们使用了一个包含7534例2型糖尿病患者的前瞻性注册表（45.6%为男性，年龄中位数（范围）为57岁（13-92岁））来对风险引擎进行内部验证。结果JADE风险引擎将患者分为4个风险级别（从低到高）：1级，n = 4520 (6%)；水平2，n = 1468 (19.5%)；3级，n = 4476 (59.4%)；水平4，n = 1138（15.1%）。中位随访期为5.5年（平均+/- sd 5.4 +/- 2.81年），763人（10.1%）死亡，1129人（14.9%）发展为心血管疾病（CVD）， 282人（3.7%）发展为终末期肾脏疾病，1400人（18.6%）至少有上述一种事件。与1级风险相比，2级、3级和4级风险与临床终点风险增加2.8倍、4.7倍和8.6倍相关。风险等级3和4分别与全因死亡风险增加2.2和3.9倍相关，与心血管疾病风险增加4.8和12.1倍相关。结论JADE风险引擎在综合评估结果的基础上，成功地将患者划分为不同的风险级别，指导临床管理。
AimsThe Joint Asia Diabetes Evaluation (JADE) Program is the first web-based program incorporating a comprehensive risk engine, care protocols, clinical decision and self-management support to improve ambulatory diabetes care. The aim was to validate the risk stratification system of the JADE Program using a large prospective cohort.MethodsThe JADE interactive risk engine stratifies patients into different risk levels using results from an annual comprehensive assessment of complications and risk factors. We used a prospective registry consisting of 7534 Type 2 diabetic patients [45.6% men, median (range) age 57 years (13-92)] to perform internal validation of the risk engine.ResultsThe JADE Risk Engine categorized patients into four risk levels (from low to high): level 1, n = 4520 (6%); level 2, n = 1468 (19.5%); level 3, n = 4476 (59.4%); and level 4, n = 1138 (15.1%). After a median follow-up period of 5.5 years (mean +/- sd 5.4 +/- 2.81 years), 763 (10.1%) died, 1129 (14.9%) developed cardiovascular disease (CVD), 282 (3.7%) developed end-stage renal disease and 1400 (18.6%) had at least one of these events. Compared with risk level 1, levels 2, 3 and 4 were associated with 2.8-, 4.7- and 8.6-fold increased risk of clinical end-points. Risk levels 3 and 4 were, respectively, associated with 2.2- and 3.9-fold increased risk for all-cause death and 4.8- and 12.1-fold increased CVD risks.ConclusionBased on results from a comprehensive assessment, the JADE Risk Engine successfully categorizes patients into different risk levels to guide clinical management.