Does early intensive multifactorial therapy reduce modelled cardiovascular risk in individuals with screen-detected diabetes? Results from the ADDITION-Europe cluster randomized trial

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  • J A Black, Denmark
  • S J Sharp
  • ,
  • N J Wareham
  • ,
  • Annelli Sandbæk
  • G E H M Rutten
  • ,
  • T Lauritzen
  • K Khunti
  • ,
  • M J Davies
  • ,
  • K Borch-Johnsen
  • ,
  • S J Griffin
  • ,
  • R K Simmons, Denmark

AIMS: Little is known about the long-term effects of intensive multifactorial treatment early in the diabetes disease trajectory. In the absence of long-term data on hard outcomes, we described change in 10-year modelled cardiovascular risk in the 5 years following diagnosis, and quantified the impact of intensive treatment on 10-year modelled cardiovascular risk at 5 years.

METHODS: In a pragmatic, cluster-randomized, parallel-group trial in Denmark, the Netherlands and the UK, 3057 people with screen-detected Type 2 diabetes were randomized by general practice to receive (1) routine care of diabetes according to national guidelines (1379 patients) or (2) intensive multifactorial target-driven management (1678 patients). Ten-year modelled cardiovascular disease risk was calculated at baseline and 5 years using the UK Prospective Diabetes Study Risk Engine (version 3β).

RESULTS: Among 2101 individuals with complete data at follow up (73.4%), 10-year modelled cardiovascular disease risk was 27.3% (sd 13.9) at baseline and 21.3% (sd 13.8) at 5-year follow-up (intensive treatment group difference -6.9, sd 9.0; routine care group difference -5.0, sd 12.2). Modelled 10-year cardiovascular disease risk was lower in the intensive treatment group compared with the routine care group at 5 years, after adjustment for baseline cardiovascular disease risk and clustering (-2.0; 95% CI -3.1 to -0.9).

CONCLUSIONS: Despite increasing age and diabetes duration, there was a decline in modelled cardiovascular disease risk in the 5 years following diagnosis. Compared with routine care, 10-year modelled cardiovascular disease risk was lower in the intensive treatment group at 5 years. Our results suggest that patients benefit from intensive treatment early in the diabetes disease trajectory, where the rate of cardiovascular disease risk progression may be slowed.

Original languageEnglish
JournalDiabetic medicine : a journal of the British Diabetic Association
Volume31
Issue6
Pages (from-to)647-56
Number of pages10
ISSN1464-5491
DOIs
Publication statusPublished - Jun 2014

    Research areas

  • Adult, Aged, Combined Modality Therapy, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Early Diagnosis, Epidemiologic Methods, Female, Humans, Male, Middle Aged, Models, Cardiovascular, Treatment Outcome

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