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dc.contributor.authorCharles, Men
dc.contributor.authorSkriver, MVen
dc.contributor.authorGriffin, Simonen
dc.contributor.authorSimmons, Rebeccaen
dc.contributor.authorWitte, DWen
dc.contributor.authorDalsgaard, E-Men
dc.contributor.authorLauritzen, Ten
dc.contributor.authorSandbaek, Aen
dc.date.accessioned2017-01-30T11:33:05Z
dc.date.available2017-01-30T11:33:05Z
dc.date.issued2017-02-02en
dc.identifier.issn1932-6203
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/262123
dc.description.abstract$\textbf{Introduction}$ Very few studies have examined the potential spill-over effect of a trial intervention in general practice. We investigated whether training and support of general practitioners in the intensive treatment of people with screen-detected diabetes improved rates of redeemed medication, morbidity and mortality in people with clinically-diagnosed diabetes. $\textbf{Methods}$ This is a secondary, post-hoc, register-based analysis linked to a cluster randomised trial. In the $\textit{ADDITION-Denmark}$ trial, 175 general practices were cluster randomised (i) to routine care, or (ii) to receive training and support in intensive multifactorial treatment of individuals with screen-detected diabetes (2001 to 2009). Using national registers we identified all individuals who were diagnosed with clinically incident diabetes in the same practices over the same time period. (Patients participating in the ADDITION trial were excluded). We compared rates of redeemed medication, a cardiovascular composite endpoint, and all-cause mortality between the routine care and intensive treatment groups. $\textbf{Results}$ In total, 4,107 individuals were diagnosed with clinically incident diabetes in $\textit{ADDITION-Denmark}$ practices between 2001 and 2009 (2,051 in the routine care group and 2,056 in the intensive treatment group). There were large and significant increases in the proportion of patients redeeming cardio-protective medication in both treatment groups during follow- up. After a median of seven years of follow-up, there was no difference in the incidence of a composite cardiovascular endpoint (HR 1.15, 95% CI 0.95 to 1.38) or all-cause mortality between the two groups (HR 1.08, 95% CI 0.94 to 1.23). $\textbf{Discussion}$ There was no evidence of a spill-over effect from an intervention promoting intensive treatment of people with screen-detected diabetes to those with clinically-diagnosed diabetes. Overall, the proportion of patients redeeming cardio-protective medication during follow-up was similar in both groups. $\textbf{Trial Registration}$ ClinicalTrials.gov NCT00237549
dc.description.sponsorshipNovo Nordisk Foundation (Grant ID: NNF14OC0008981)
dc.publisherPublic Library of Science (PLoS)
dc.rightsAttribution 4.0 Internationalen
dc.rightsAttribution 4.0 Internationalen
dc.rightsAttribution 4.0 Internationalen
dc.rightsAttribution 4.0 Internationalen
dc.rightsAttribution 4.0 Internationalen
dc.rightsAttribution 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.titleDoes Training and Support of General Practitioners in Intensive Treatment of People with Screen-Detected Diabetes Improve Medication, Morbidity and Mortality in People with Clinically-Diagnosed Diabetes? Investigation of a Spill-Over Effect in a Cluster RCTen
dc.typeArticle
prism.issueIdentifier2en
prism.numbere0170697en
prism.publicationDate2017en
prism.publicationNamePLoS ONEen
prism.volume12en
dc.identifier.doi10.17863/CAM.7371
dcterms.dateAccepted2017-01-09en
rioxxterms.versionofrecord10.1371/journal.pone.0170697en
rioxxterms.versionVoRen
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by/4.0/en
rioxxterms.licenseref.startdate2017-02-02en
dc.contributor.orcidGriffin, Simon [0000-0002-2157-4797]
dc.contributor.orcidSimmons, Rebecca [0000-0002-7726-8529]
dc.identifier.eissn1932-6203
rioxxterms.typeJournal Article/Reviewen
pubs.funder-project-idMRC (MC_UU_12015/4)
pubs.funder-project-idNIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC) (HTA/08/116/300)
pubs.funder-project-idNIHR Central Commissioning Facility (NIHRDH-RP-PG-0606-1259)
cam.orpheus.successThu Jan 30 12:56:46 GMT 2020 - The item has an open VoR version.*
rioxxterms.freetoread.startdate2100-01-01


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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International