Cardiovascular risk reduction following diagnosis of diabetes by screening: 1-year results from the ADDITION-Cambridge trial cohort

Charles, Morten; Simmons, Rebecca K.; Williams, Kate; Roglić, Gojka; Sharp, Stephen J.; Kinmonth, Ann‐Louise; Wareham, Nicholas J.; Griffin, Simon J.

doi:10.3399/bjgp12x649070

Cited by 9 publications

(7 citation statements)

References 43 publications

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“… 50 51 In contrast, recent data from the ADDITION trial 52 does not show a reduction in mortality with screening for diabetes. In terms of biomarkers, our data support the assumption that a diagnosis can be beneficial, 53 particularly for lipid and blood pressure modification: people who are diagnosed will benefit from QOF and guideline-driven risk factor modification, resulting in a stalling or reduction of cardiovascular risk factor progression despite advancing disease. However, self-reported health was worst in this group.…”

Section: Discussionsupporting

confidence: 71%

Social inequalities in prevalence of diagnosed and undiagnosed diabetes and impaired glucose regulation in participants in the Health Surveys for England series

Moody¹,

Cowley

Fat³

et al. 2016

BMJ Open

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ObjectivesTo ascertain the extent of socioeconomic and health condition inequalities in people with diagnosed and undiagnosed diabetes and impaired glucose regulation (IGR) in random samples of the general population in England, as earlier diagnosis of diabetes and treatment of people with IGR can reduce adverse sequelae of diabetes. Various screening instruments were compared to identify IGR, in addition to undiagnosed diabetes.Design5, annual cross-sectional health examination surveys; data adjusted for complex survey design.SettingRandom selection of private homes across England, new sample annually 2009–2013.Participants5, nationally representative random samples of the general, free-living population: ≥1 adult interviewed in 24 254 of 36 889 eligible addresses selected. 18 399 adults had a valid glycated haemoglobin (HbA1c) measurement and answered the diabetes questions.Main outcome measuresDiagnosed diabetes, undiagnosed diabetes (HbA1c ≥48 mmol/mol), IGR (HbA1c 42–47 mmol/mol).ResultsOverall, 11% of the population had IGR, 2% undiagnosed and 6% diagnosed diabetes. Age-standardised prevalence was highest among Asian (19% (95% CI 16% to 23%), 3% (2% to 5%) and 12% (9% to 16%) respectively) and black participants (17% (13% to 21%), 2% (1% to 4%) and 14% (9% to 20%) respectively). These were also higher among people with lower income, less education, lower occupational class and greater deprivation. Education (OR 1.49 (95% CI 1.27 to 1.74) for no qualifications vs degree or higher) and income (1.35 (1.12 to 1.62) for lowest vs highest income quintile) remained significantly associated with IGR or undiagnosed diabetes on multivariate regression. The greatest odds of IGR or undiagnosed diabetes were with increasing age over 34 years (eg, OR 18.69 (11.53 to 30.28) aged 65–74 vs 16–24). Other significant associations were ethnic group (Asian (3.91 (3.02 to 5.05)), African-American (2.34 (1.62 to 3.38)) or ‘other’ (2.04 (1.07 to 3.88)) vs Caucasian); sex (OR 1.32(1.19 to 1.46) for men vs women); body mass index (3.54 (2.52 to 4.96) for morbidly obese vs not overweight); and waist circumference (2.00 (1.67 to 2.38) for very high vs low).ConclusionsSocial inequalities in hyperglycaemia exist, additional to well-known demographic and anthropometric risk factors for diabetes and IGR.

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Section: Discussionsupporting

confidence: 71%

Social inequalities in prevalence of diagnosed and undiagnosed diabetes and impaired glucose regulation in participants in the Health Surveys for England series

Moody¹,

Cowley

Fat³

et al. 2016

BMJ Open

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“…Coverage of the Health Check programme between 2009 and 2011 ranged from 0.5 to 61.6% with median values (interquartile range) of: (i) 8.5% (6.3 to 10.2%); (ii) 15.4% (13.6 to 17.5%); and (iii) 26.3% (22.8 to 34.6%) among low, medium, and high programme coverage practices, respectively. The three groups were largely similar in terms of sex and mean age at baseline, while they differed in ethnicity, smoking status, BMI, and prescription of anti-hypertensive treatment ( Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…The clinical benefits of large-scale programmes directed at the identification and management of individuals at high risk of diabetes remain unclear 7,10-13 . Evidence from randomised trials suggests that early detection of abnormal glucose metabolism through screening and subsequent intensive management reduce cardiovascular risk among individuals with NDH and newly diagnosed T2D 11,26 . The results of the ADDITION-Denmark study suggest that diabetes screening was associated with a significant reduction in risk of all-cause mortality and CVD events in those diagnosed with diabetes 27 .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Diabetes Screening Component of a National Cardiovascular Risk Assessment Programme in England: a Retrospective Cohort Study

Palladino

Vámos

Chang

et al. 2020

Sci Rep

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Type 2 Diabetes (T2D) is increasing but the effectiveness of large-scale diabetes screening programmes is debated. We assessed associations between coverage of a national cardiovascular and diabetes risk assessment programme in England (NHS Health Check) and detection and management of incident cases of non-diabetic hyperglycaemia (NDH) and T2D. Retrospective analysis employing propensity score covariate adjustment method of prospectively collected data of 348,987 individuals aged 40-74 years and registered with 455 general practices in England (January 2009-May 2016). We examined differences in diagnosis of NDH and T2D, and changes in blood glucose levels and cardiovascular risk score between individuals registered with general practices with different levels (tertiles) of programme coverage. Over the study period 7,126 cases of NDH and 12,171 cases of T2D were detected. Compared with low coverage practices, incidence rate of detection in medium and high coverage practices were 15% and 19% higher for NDH and 10% and 9% higher for T2D, respectively. Individuals with NDH in high coverage practices had 0.2 mmol/L lower mean fasting plasma glucose and 0.9% lower cardiovascular risk score at follow-up. General practices actively participating in the programme had higher detection of NDH and T2D and improved management of blood glucose and cardiovascular risk factors.

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“…While the reduction in risk of cardiovascular events associated with the intervention was not statistically significant (hazard ratio = 0.83, 95% confidence interval [CI] = 0.65 to 1.05), there was no increase in modelled CVD risk in the 5 years following diagnosis, despite increasing age and diabetes duration. However, many patients were not prescribed recommended treatments 8,9. In a screen-detected population that is free of symptoms, primary care teams may be reluctant to prescribe intensive treatment,10 and patients may be reluctant to adhere, particularly if they only experience complications related to medications in the short term 11.…”

Section: Introductionmentioning

confidence: 99%

Change in cardiovascular risk factors following early diagnosis of type 2 diabetes: a cohort analysis of a cluster-randomised trial

et al. 2014

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BackgroundThere is little evidence to inform the targeted treatment of individuals found early in the diabetes disease trajectory.AimTo describe cardiovascular disease (CVD) risk profiles and treatment of individual CVD risk factors by modelled CVD risk at diagnosis; changes in treatment, modelled CVD risk, and CVD risk factors in the 5 years following diagnosis; and how these are patterned by socioeconomic status.Design and settingCohort analysis of a cluster-randomised trial (ADDITION-Europe) in general practices in Denmark, England, and the Netherlands.MethodA total of 2418 individuals with screen-detected diabetes were divided into quartiles of modelled 10-year CVD risk at diagnosis. Changes in treatment, modelled CVD risk, and CVD risk factors were assessed at 5 years.ResultsThe largest reductions in risk factors and modelled CVD risk were seen in participants who were in the highest quartile of modelled risk at baseline, suggesting that treatment was offered appropriately. Participants in the lowest quartile of risk at baseline had very similar levels of modelled CVD risk at 5 years and showed the least variation in change in modelled risk. No association was found between socioeconomic status and changes in CVD risk factors, suggesting that treatment was equitable.ConclusionDiabetes management requires setting of individualised attainable targets. This analysis provides a reference point for patients, clinicians, and policymakers when considering goals for changes in risk factors early in the course of the disease that account for the diverse cardiometabolic profile present in individuals who are newly diagnosed with type 2 diabetes.

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Cardiovascular risk reduction following diagnosis of diabetes by screening: 1-year results from the ADDITION-Cambridge trial cohort

Cited by 9 publications

References 43 publications

Social inequalities in prevalence of diagnosed and undiagnosed diabetes and impaired glucose regulation in participants in the Health Surveys for England series

Social inequalities in prevalence of diagnosed and undiagnosed diabetes and impaired glucose regulation in participants in the Health Surveys for England series

Evaluation of the Diabetes Screening Component of a National Cardiovascular Risk Assessment Programme in England: a Retrospective Cohort Study

Change in cardiovascular risk factors following early diagnosis of type 2 diabetes: a cohort analysis of a cluster-randomised trial

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