Intensive versus standard multifactorial cardiovascular risk factor control in screen-detected type 2 diabetes: 5-year and longer-term modelled outcomes of the ADDITION-Leicester study.
Diabetes/metabolism research and reviews
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Webb, D., Dales, J., Zaccardi, F., Hill, S., Moore, C., Farooqi, A., Griffin, S., et al. (2019). Intensive versus standard multifactorial cardiovascular risk factor control in screen-detected type 2 diabetes: 5-year and longer-term modelled outcomes of the ADDITION-Leicester study.. Diabetes/metabolism research and reviews, 35 (3), e3111. https://doi.org/10.1002/dmrr.3111
Introduction Type 2 diabetes treatment algorithms recommend intensive intervention in younger patients and in those with a shorter duration of disease. Screening provides opportunities for earlier multifactorial cardiovascular risk factor control which maybe particularly effective if targeted at populations known to have poorer long-term outcomes. Using the ADDITION-Leicester multi-ethnic study, we estimated the effects of intensive risk factor control on modelled risk of diabetes related complications. Methods 345 (41% South Asian) people aged between 40 and 70 years with screen-detected type 2 diabetes were randomised for five years to receive either 1) intensive multifactorial risk factor intervention or 2) standard care according to national guidance. Estimated risk of death, ischaemic heart disease, stroke, congestive cardiac failure and blindness were calculated using United Kingdom Prospective Diabetes study risk equations. Results After 5 years of follow-up, compared to standard care mean treatment differences for intensive care were -11.7 (95% CI: -15.0, -8.4) and -6.6 (-8.8, -4.4) mmHg for systolic and diastolic blood pressure, respectively; -0.27 (-0.66, -0.26) % for HbA1c; and -0.46 (-0.66; -0.26), -0.34 (-0.51; -0.18), and -0.19 (-0.28; -0.10) mmol/l for total cholesterol, LDL-cholesterol, and triglycerides, respectively. There was no significant weight gain in the intensive group despite additional medication use. Modelled risks were consistently lower for intensively managed patients: the benefit of intensive versus routine care was progressively higher over-time for ischaemic heart disease (3.5% and 6.2% reduction at 10 and 20 years, respectively) and stroke (6.3% and 8.8% reduction), while the risk reduction for congestive heart failure plateaued at around 15 years (5.3% reduction). No differences were observed for blindness and all-cause death. Conclusion Intensive multifactorial intervention in a multi-ethnic population with screen-detected type 2 diabetes results in sustained improvements in modelled ischaemic heart disease, stroke and congestive cardiac failure.
Humans, Cardiovascular Diseases, Diabetic Angiopathies, Diabetes Mellitus, Type 2, Mass Screening, Prognosis, Models, Statistical, Risk Factors, Follow-Up Studies, Adult, Aged, Middle Aged, Female, Male
We acknowledge the support from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care – East Midlands (NIHR CLAHRC – EM), the Leicester Clinical Trials Unit, and the NIHR Leicester BRC (Biomedical Research Centre). This report is independent research funded by the National Institute for Health Research.
NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC) (HTA/08/116/300)
NIHR Central Commissioning Facility (NIHRDH-RP-PG-0606-1259)
Department of Health (via National Institute for Health Research (NIHR)) (NF-SI-0515-10119)
Department of Health (via National Institute for Health Research (NIHR)) (NF-SI-0512-10135)
UNIVERSITY OF AARHUS (not known)
Department of Health (via National Institute for Health Research (NIHR)) (NF-SI-0617-10149)
External DOI: https://doi.org/10.1002/dmrr.3111
This record's URL: https://www.repository.cam.ac.uk/handle/1810/287378