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Randomized Controlled Trial
. 2015 Mar;13(2):149-57.
doi: 10.1370/afm.1737.

Long-term effect of population screening for diabetes on cardiovascular morbidity, self-rated health, and health behavior

Justin B Echouffo-Tcheugui  1 , Rebecca K Simmons  1 , A Toby Prevost  2 , Kate M Williams  3 , Ann-Louise Kinmonth  3 , Nicholas J Wareham  1 , Simon J Griffin  4
Affiliations
Randomized Controlled Trial

Long-term effect of population screening for diabetes on cardiovascular morbidity, self-rated health, and health behavior

Justin B Echouffo-Tcheugui et al. Ann Fam Med. 2015 Mar.

Abstract

Purpose: There is limited trial evidence concerning the long-term effects of screening for type 2 diabetes on population morbidity. We examined the effect of a population-based diabetes screening program on cardiovascular morbidity, self-rated health, and health-related behaviors.

Methods: We conducted a pragmatic, parallel-group, cluster-randomized controlled trial of diabetes screening (the ADDITION-Cambridge study) including 18,875 individuals aged 40 to 69 years at high risk of diabetes in 32 general practices in eastern England (27 practices randomly allocated to screening, 5 to no-screening for control). Of those eligible for screening, 466 (2.9%) were diagnosed with diabetes. Seven years after randomization, a random sample of patients was sent a postal questionnaire: 15% from the screening group (including diabetes screening visit attenders and non-attenders) and 40% from the no-screening control group. Self-reported cardiovascular morbidity, self-rated health (using the SF-8 Health Survey and EQ-5D instrument), and health behaviors were compared between trial groups using an intention-to-screen analysis.

Results: Of the 3,286 questionnaires mailed out, 1,995 (61%) were returned, with 1,945 included in the analysis (screening: 1,373; control: 572). At 7 years, there were no significant differences between the screening and control groups in the proportion of participants reporting heart attack or stroke (OR = 0.90, 95% CI, 0.71-1.15); SF-8 physical health summary score as an indicator of self-rated health status (β -0.33, 95% CI, -1.80 to 1.14); EQ-5D visual analogue score (β: 0.80, 95% CI, -1.28 to 2.87); total physical activity (β 0.50, 95% CI, -4.08 to 5.07); current smoking (OR 0.97, 95% CI, 0.72 to 1.32); and alcohol consumption (β 0.14, 95% CI, -1.07 to 1.35).

Conclusions: Invitation to screening for type 2 diabetes appears to have limited impact on population levels of cardiovascular morbidity, self-rated health status, and health behavior after 7 years.

Keywords: ADDITION-Cambridge; cardiovascular morbidity; diabetes; health behavior; screening; self-rated health.

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Figures

Figure 1
Figure 1
Practice and participant flow in the ADDITION-Cambridge diabetes screening trial.
See this image and copyright information in PMC

Comment in

References

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