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Controlled Clinical Trial
. 2017 Nov;60(11):2183-2191.
doi: 10.1007/s00125-017-4323-2. Epub 2017 Aug 23.

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

Rebecca K Simmons  1   2   3   4   5 , Simon J Griffin  6   7   8 , Daniel R Witte  9   10 , Knut Borch-Johnsen  11 , Torsten Lauritzen  7 , Annelli Sandbæk  7
Affiliations
Controlled Clinical Trial

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

Rebecca K Simmons et al. Diabetologia. 2017 Nov.

Abstract

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.

Keywords: Cardiovascular disease; General practice; Mortality rate; Population; Screening; Type 2 diabetes.

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Conflict of interest statement

Data availability

The data used in this paper was a combination of data obtained from the ADDITION study and data from national Danish registers at Statistics Denmark (DST). The ADDITION study data were obtained after a written application to the data owner, A. Sandbæk (Institute of Public Health, Aarhus University, Aarhus, Denmark; annelli.sandbaek@ph.au.dk). Data from DST were made available following an application to DST (www.dst.dk/en/TilSalg/Forskningsservice). Data from ADDITION and DST were merged by DST and analyses were performed via a secure Virtual Private Network (VPN) connection. In accordance with the Danish Act on Processing of Personal Data, future interested researchers must perform the steps mentioned above to obtain access to the data.

Duality of interest

RKS was supported by the European Foundation for the Study of Diabetes under an Albert Renold Travel grant to complete part of this work. DRW and RKS are supported by the Danish Diabetes Academy, which is funded by the Novo Nordisk Foundation. RKS is further supported by the Aarhus Institute of Advanced Studies. DRW reports receiving lecture fees from Novo Nordisk and Steno Diabetes Center. DRW and TL hold shares in Novo Nordisk. TL reports receiving a fee for attending an international board meeting for Astra Zeneca on early detection and treatment of diabetes in 2015. AS reports receiving lecture fees for providing continuing medical education to GPs. SJG’s research programme is supported by Medical Research Council (MRC) Epidemiology Unit core funding (MC_UU_12015/4). SJG is a National Institute for Health Research (NIHR) Senior Investigator and member of the NIHR School for Primary Care Research. SJG receives an honorarium and reimbursement of travel expenses from Eli Lilly associated with membership of an independent data monitoring committee for a randomised trial of a medication to lower glucose. SJG received an honorarium from Janssen for speaking at an educational meeting in 2015. KB-J has no duality of interest associated with this manuscript.

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Fig. 1
ADDITION-Denmark screening flow
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