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Randomized Controlled Trial
. 2012 Jun;62(599):e396-402.
doi: 10.3399/bjgp12X649070.

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

Morten Charles  1 , Rebecca K Simmons, Kate M Williams, Gojka Roglic, Stephen J Sharp, Ann-Louise Kinmonth, Nicholas J Wareham, Simon J Griffin
Affiliations
Randomized Controlled Trial

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

Morten Charles et al. Br J Gen Pract. 2012 Jun.

Abstract

Background: Uncertainties persist concerning the effects of early intensive management of type 2 diabetes and which patients benefit most from such an approach.

Aim: To describe change in modelled cardiovascular risk in the 14 months following diagnosis, and to examine which baseline patient characteristics and treatment components are associated with risk reduction.

Design and setting: A cohort of individuals from a pragmatic, single-blind, cluster-randomised controlled trial of 236 females and 361 males with screen-detected type 2 diabetes and without prior cardiovascular disease (CVD), from 49 GP surgeries in eastern England, examined at baseline (2002-2006) and after 14-months' follow-up.

Method: Multiple linear regression was used to quantify the association between baseline patient characteristics, treatment components, and change in modelled 10-year cardiovascular risk (UK Prospective Diabetes Study [UKPDS] [version 3] risk engine).

Results: There was a downward shift in the distribution of modelled CVD risk over 14 months mean 31% (standard deviation [SD] = 14%) to 26% [SD = 13%]). Older individuals, males, and those with a larger waist circumference at baseline exhibited smaller risk reductions. Individuals prescribed higher numbers of drugs over the follow-up period, and those who decreased their energy intake or reduced their weight, demonstrated larger reductions in modelled risk.

Conclusion: It is possible to achieve significant reductions in modelled CVD risk over 14 months following diagnosis of diabetes by screening. Risk reduction appeared to be driven mainly by prescription of higher numbers of drugs, decreased energy intake, and weight reduction. There was room for further risk reduction, as many patients were not prescribed recommended treatments.

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Figures

Figure 1
Figure 1
Distribution of 10-year modelled cardiovascular disease (CVD) risk (UKPDS risk engine, version 3) at baseline and follow-up in the ADDITION-Cambridge cohort.
Figure 2
Figure 2
Change in modelled 10-year cardiovascular disease (CVD) risk (UKPDS risk engine version 3). CVD risk change = follow-up CVD risk — baseline CVD risk, adjusted for baseline CVD risk, treatment group, and taking cluster effect into account, in relation to change in total numbers of prescribed cardiovascular drugs from baseline to 14 months’ follow-up.
See this image and copyright information in PMC

References

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