title: Randomised controlled trial of intensive multifactorial treatment for cardiovascular risk in patients with screen-detected type 2 diabetes: 1-year data from the ADDITION Netherlands study.
abstract: BACKGROUND
  A growing body of evidence suggests that earlier diagnosis and treatment of diabetes may be beneficial; however, definitive evidence is lacking.
  
  
  OBJECTIVE
  To evaluate the effectiveness of an intensified multifactorial treatment on cardiovascular risk factors in patients with screen-detected type 2 diabetes.
  
  
  METHODS
  Randomised controlled trial.
  
  
  METHODS
  Seventy-nine general practices in the southwestern region of the Netherlands.
  
  
  METHODS
  In this randomised trial, patients diagnosed with diabetes by screen-detection were assigned to intensified (n = 255) or routine treatment (n = 243), and followed over 1 year. Intensified treatment consisted of pharmacological treatment combined with lifestyle education to achieve haemoglobin A1c (HbA1c) <7.0%, blood pressure <135/85 mmHg, and cholesterol <5.0 mmol/l (4.5 mmol/l if cardiovascular disease was present). Health-related quality of life (HRQoL) was assessed using the Short Form (SF)-36. Analyses were performed using generalised estimating equations models.
  
  
  RESULTS
  Changes in body mass index were 0.2 (routine care) versus -1.4 kg/m(2) (intensified treatment), P<0.001; systolic blood pressure -19 versus -33 mmHg, P<0.001; diastolic blood pressure -7 versus -12 mmHg, P<0.001; HbA1c -0.9% versus -1.1%, P = 0.03; cholesterol -0.5 versus -1.2 mmol/l, P<0.001; high-density lipoprotein cholesterol 0.1 versus 0.1 mmol/l, P = 0.26; low-density lipoprotein cholesterol -0.5 versus -1.0 mmol/l, P<0.001; triglycerides -0.3 versus -0.4 mmol/l, P = 0.71. No difference in HRQoL between the two groups was reported.
  
  
  CONCLUSIONS
  Intensified multifactorial treatment of patients with screen-detected diabetes in general practice reduces cardiovascular risk factor levels significantly without worsening HRQoL.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands. pjanssen@nlzorg.net
authors.forename: Paul Gh
authors.initials: PG
authors.lastname: Janssen
authors.forename: Kees J
authors.initials: KJ
authors.lastname: Gorter
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Stolk
authors.forename: Guy Ehm
authors.initials: GE
authors.lastname: Rutten
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D002784:Cholesterol / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000517:prevention & control; D005194:Family Practice; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D011788:Quality of Life; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents; D002784:Cholesterol; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents