Conclusions
This longitudinal comparative study in a pragmatic primary care setting found that a multidisciplinary risk assessment and management program for people with diabetes (RAMP-DM) significantly reduced HbA1c, observed CVD events and predicted 10-year cardiovascular risks over 12 months follow-up. The encouraging results support the risk stratification and multidisciplinary approach for the management of diabetic patients. A further study focusing on the longer term effects of RAMP-DM in terms of the cardiovascular risk control and the effects of the frequency of interventions will be conducted at three years follow-up.