Incidence of register-based diabetes 10 years after a stepwise diabetes screening programme: the ADDITION-Denmark study

Rasmussen, Søren; Johansen, Nanna Borup; Witte, Daniel R.; Borch‐Johnsen, Knut; Sandbæk, Annelli; Lauritzen, Torsten; Jørgensen, Marit Eika

doi:10.1007/s00125-016-3887-6

Cited by 10 publications

(8 citation statements)

References 25 publications

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“…The presence of IGT conferred a lower risk than IFG, while the combination of both multiplied the risk of developing diabetes, especially in women. A similar effect has been found in the ADDITION-Denmark study 26 . The importance of detecting an early dysglicemia lies not only in the increased risk of developing diabetes over time, but also in the higher risk of developing cardiovascular and renal disease, and the higher mortality than normoglycemic subjects 27 .…”

Section: Discussionsupporting

confidence: 87%

“…This may be due to the fact that these variables are not causative of diabetes, but they rather share a common pathophysiology, probably linked to the loss of insulin sensitivity 25 . The main predictor variable has been the presence of dysglicemia in the baseline study, as it happened in other studies 14,17,18,26 . The presence of IGT conferred a lower risk than IFG, while the combination of both multiplied the risk of developing diabetes, especially in women.…”

Section: Discussionmentioning

confidence: 93%

“…In the follow-up, HbA1c was also used, which guarantees the capture of most of the incident diabetes. Most published studies on diabetes incidence perform incidence estimates based on health records or self-reported diabetes and therefore may underestimate the real incidence of diabetes 5,6,26,31,32 .…”

Section: Discussionmentioning

confidence: 99%

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Incidence of diabetes mellitus in Spain as results of the nation-wide cohort di@bet.es study

Rojo-Martínez

Valdés

Soriguer

et al. 2020

Sci Rep

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Our aim was to determine the incidence of type 2 diabetes mellitus in a nationwide population based cohort from Spain (di@bet.es study). The target was the Spanish population. In total 5072 people older than 18 years,were randomly selected from all over Spain). Socio-demographic and clinical data, survey on habits (physical activity and food consumption) and weight, height, waist, hip and blood pressure were recorder. A fasting blood draw and an oral glucose tolerance test were performed. Determinations of serum glucose were made. In the follow-up the same variables were collected and HbA1c was determined. A total of 2408 subjects participated in the follow-up. In total, 154 people developed diabetes (6.4% cumulative incidence in 7.5 years of follow-up). The incidence of diabetes adjusted for the structure of age and sex of the Spanish population was 11.6 cases/1000 person-years (IC95% = 11.1-12.1). The incidence of known diabetes was 3.7 cases/1000 person-years (IC95% = 2.8-4.6). The main risk factors for developing diabetes were the presence of prediabetes in cross-sectional study, age, male sex, obesity, central obesity, increase in weight, and family history of diabetes. This work provides data about population-based incidence rates of diabetes and associated risk factors in a nationwide cohort of Spanish population.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 93%

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Incidence of diabetes mellitus in Spain as results of the nation-wide cohort di@bet.es study

Rojo-Martínez

Valdés

Soriguer

et al. 2020

Sci Rep

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“…Danish GPs were encouraged to intervene in individuals with IFG/IGT and those with high CVD risk but without diagnosed diabetes. While small numbers of individuals were diagnosed with diabetes following screening in Denmark (1%), 1.6% were found with IFG/IGT and 48% with elevated cardiovascular risk (SCORE > 5 points), providing a larger at-risk group with the potential to benefit from interventions to prevent both diabetes and CVD [ 25 , 26 ]. Indeed, larger proportions of people in the screening practices redeemed cardioprotective medication compared with the control practices during the screening phase of the study (2001–2006).…”

Section: Discussionmentioning

confidence: 99%

Effect of population screening for type 2 diabetes and cardiovascular risk factors on mortality rate and cardiovascular events: a controlled trial among 1,912,392 Danish adults

et al. 2017

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Aims/hypothesis Health check programmes for chronic disease have been introduced in a number of countries. However, there are few trials assessing the benefits and harms of these screening programmes at the population level. In a post hoc analysis, we evaluated the effect of population-based screening for type 2 diabetes and cardiovascular risk factors on mortality rates and cardiovascular events. Methods This register-based, non-randomised, controlled trial included men and women aged 40-69 years without known diabetes who were registered with a general practice in Denmark (n = 1,912,392). Between 2001 and 2006, 153,107 individuals registered with 181 practices participating in the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION)-Denmark study were sent a diabetes risk score questionnaire. Individuals at moderate-to-high risk were invited to visit their GP for assessment of diabetes status and cardiovascular risk (screening group). The 1,759,285 individuals registered with all other general practices in Denmark constituted the retrospectively constructed no-screening (control) group. Outcomes were mortality rate and cardiovascular events (cardiovascular disease death, non-fatal ischaemic heart disease or stroke). The analysis was performed according to the intention-to-screen principle. Results Among the screening group, 27,177 (18%) individuals attended for assessment of diabetes status and cardiovascular risk. Of these, 1,533 were diagnosed with diabetes. During a median follow-up of 9.5 years, there were 11,826 deaths in the screening group and 141,719 in the no-screening group (HR 0.99 [95% CI 0.96, 1.02], p = 0.66). There were 17,941 cardiovascular events in the screening group and 208,476 in the no-screening group (HR 0.99 [0.96, 1.02], p = 0.49). Conclusions/interpretation A population-based stepwise screening programme for type 2 diabetes and cardiovascular risk factors among all middle-aged adults in Denmark was not associated with a reduction in rate of mortality or cardiovascular events between 2001 and 2012.

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“…Rasmussen et al (9) reported on the value of a very comprehensive and thought-provoking stepwise screening program that stratified diabetes risk. In addition to the other categories, they also used a lower cut point for IFG defined as ≥5.6 mmol/L but <6.1 mmol/L (100–110 mg/dL) and 2-h blood glucose <7.8 mmol/L (140 mg/dL).…”

Section: Risk Of Progression Of Ifg To Diabetes?mentioning

confidence: 99%

“Prediabetes”: Are There Problems With This Label? No, We Need Heightened Awareness of This Condition!

Cefalu

2016

Diabetes Care

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The category of “prediabetes” defined by the American Diabetes Association comprises a range of intermediate hyperglycemia based on fasting or 2-h postload glucose or on HbA1c. Over the recent past, the “cut points” identifying this stage have changed, i.e., a lower fasting glucose level is used. On one hand, it can be argued that the change to a lower cut point identifies a group of individuals still at higher risk and provides heightened awareness for a condition associated with higher risk for cardiovascular disease. In addition, identification of individuals at this stage may represent a chance of earlier intervention in the disease. However, the argument against this definition of prediabetes is that it disguises the differences in the three subcategories and creates problems in interpreting observations on interventions and outcomes. In addition, it can be argued that the enormous numbers of people identified with the criteria far exceeds the capacity of health care systems to respond through individual care, particularly without evidence that interventions benefit any category other than impaired glucose tolerance. Thus, there does not appear to be consensus on the definition using the cut points identified. Controversy also remains as to whether there are glycemic metrics beyond HbA1c that can be used in addition to HbA1c to help assess risk of an individual developing diabetes complications. Given the current controversy, a Point-Counterpoint debate on this issue is provided herein. In the preceding point narrative, Dr. Yudkin provides his argument that there are significant problems with this label. In the counterpoint narrative below, Dr. Cefalu argues that the cut points are appropriate and do provide useful and important information in trying to reduce the future burden of diabetes.—William T. CefaluEditor in Chief, Diabetes Care

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Incidence of register-based diabetes 10 years after a stepwise diabetes screening programme: the ADDITION-Denmark study

Cited by 10 publications

References 25 publications

Incidence of diabetes mellitus in Spain as results of the nation-wide cohort di@bet.es study

Incidence of diabetes mellitus in Spain as results of the nation-wide cohort di@bet.es study

Effect of population screening for type 2 diabetes and cardiovascular risk factors on mortality rate and cardiovascular events: a controlled trial among 1,912,392 Danish adults

“Prediabetes”: Are There Problems With This Label? No, We Need Heightened Awareness of This Condition!

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