Journal Article

Effect of early intensive multifactorial therapy on 5-year cardiovascular outcomes in individuals with type 2 diabetes detected by screening (ADDITION-Europe): a cluster-randomised trial

Griffin, Simon J, Borch-Johnsen, Knut, Simmons, Rebecca K, Khunti, Kamlesh, Sandbæk, Annelli, Wareham, Nicholas J, Lauritzen, Torsten, Davies, Melanie J, Rutten, Guy EHM, Sharp, Stephen J, van den Donk, Maureen

2011

Overview

Intensive treatment of multiple cardiovascular risk factors can halve mortality among people with established type 2 diabetes. We investigated the effect of early multifactorial treatment after diagnosis by screening. In a pragmatic, cluster-randomised, parallel-group trial done in Denmark, the Netherlands, and the UK, 343 general practices were randomly assigned screening of registered patients aged 40–69 years without known diabetes followed by routine care of diabetes or screening followed by intensive treatment of multiple risk factors. The primary endpoint was first cardiovascular event, including cardiovascular mortality and morbidity, revascularisation, and non-traumatic amputation within 5 years. Patients and staff assessing outcomes were unaware of the practice's study group assignment. Analysis was done by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00237549. Primary endpoint data were available for 3055 (99·9%) of 3057 screen-detected patients. The mean age was 60·3 (SD 6·9) years and the mean duration of follow-up was 5·3 (SD 1·6) years. Improvements in cardiovascular risk factors (HbA 1c and cholesterol concentrations and blood pressure) were slightly but significantly better in the intensive treatment group. The incidence of first cardiovascular event was 7·2% (13·5 per 1000 person-years) in the intensive treatment group and 8·5% (15·9 per 1000 person-years) in the routine care group (hazard ratio 0·83, 95% CI 0·65–1·05), and of all-cause mortality 6·2% (11·6 per 1000 person-years) and 6·7% (12·5 per 1000 person-years; 0·91, 0·69–1·21), respectively. An intervention to promote early intensive management of patients with type 2 diabetes was associated with a small, non-significant reduction in the incidence of cardiovascular events and death. National Health Service Denmark, Danish Council for Strategic Research, Danish Research Foundation for General Practice, Danish Centre for Evaluation and Health Technology Assessment, Danish National Board of Health, Danish Medical Research Council, Aarhus University Research Foundation, Wellcome Trust, UK Medical Research Council, UK NIHR Health Technology Assessment Programme, UK National Health Service R&D, UK National Institute for Health Research, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Novo Nordisk, Astra, Pfizer, GlaxoSmithKline, Servier, HemoCue, Merck.

• Publisher: Elsevier Ltd,Elsevier,Elsevier Limited,Lancet Publishing Group
• Subject: Aged / amputation / Biochemistry / Biological and medical sciences / Biomedical research / Blood pressure / cholesterol / Cluster Analysis / Councils / death / Denmark / Denmark - epidemiology / Diabetes / Diabetes Mellitus, Type 2 - diagnosis / Diabetes Mellitus, Type 2 - drug therapy / Diabetes Mellitus, Type 2 - mortality / Diabetes Mellitus, Type 2 - therapy / Diabetes. Impaired glucose tolerance / Diabetic Angiopathies - mortality / Diabetic Angiopathies - prevention & control / Endocrine pancreas. Apud cells (diseases) / Endocrinopathies / Etiopathogenesis. Screening. Investigations. Target tissue resistance / Female / General aspects / Grants / Health psychology / Health risks / Health sciences / Health services / Heart attacks / Humans / Hypoglycemic Agents - therapeutic use / Intention to Treat Analysis / Internal Medicine / Male / Mass Screening / Medical research / Medical sciences / Meetings / Middle Aged / morbidity / Mortality / Netherlands / Netherlands - epidemiology / noninsulin-dependent diabetes mellitus / Outcome Assessment, Health Care / patients / people / Prevention and actions / Primary care / Public health. Hygiene / Public health. Hygiene-occupational medicine / R&D / Research & development / Risk assessment / Risk Factors / screening / Technology assessment / Trust departments / United Kingdom / United Kingdom - epidemiology