The ADDITION-Cambridge trial protocol: a cluster -- randomised controlled trial of screening for type 2 diabetes and intensive treatment for screen-detected patients.
BACKGROUND
The increasing prevalence of type 2 diabetes poses a major public health challenge. Population-based screening and early treatment for type 2 diabetes could reduce this growing burden. However, the benefits of such a strategy remain uncertain.


METHODS
The ADDITION-Cambridge study aims to evaluate the effectiveness and cost-effectiveness of (i) a stepwise screening strategy for type 2 diabetes; and (ii) intensive multifactorial treatment for people with screen-detected diabetes in primary care. 63 practices in the East Anglia region participated. Three undertook the pilot study, 33 were allocated to three groups: no screening (control), screening followed by intensive treatment (IT) and screening plus routine care (RC) in an unbalanced (1:3:3) randomisation. The remaining 27 practices were randomly allocated to IT and RC. A risk score incorporating routine practice data was used to identify people aged 40-69 years at high-risk of undiagnosed diabetes. In the screening practices, high-risk individuals were invited to take part in a stepwise screening programme. In the IT group, diabetes treatment is optimised through guidelines, target-led multifactorial treatment, audit, feedback, and academic detailing for practice teams, alongside provision of educational materials for newly diagnosed participants. Primary endpoints are modelled cardiovascular risk at one year, and cardiovascular mortality and morbidity at five years after diagnosis of diabetes. Secondary endpoints include all-cause mortality, development of renal and visual impairment, peripheral neuropathy, health service costs, self-reported quality of life, functional status and health utility. Impact of the screening programme at the population level is also assessed through measures of mortality, cardiovascular morbidity, health status and health service use among high-risk individuals.


CONCLUSIONS
ADDITION-Cambridge is conducted in a defined high-risk group accessible through primary care. It addresses the feasibility of population-based screening for diabetes, as well as the benefits and costs of screening and intensive multifactorial treatment early in the disease trajectory. The intensive treatment algorithm is based on evidence from studies including individuals with clinically diagnosed diabetes and the education materials are informed by psychological theory. ADDITION-Cambridge will provide timely evidence concerning the benefits of early intensive treatment and will inform policy decisions concerning screening for type 2 diabetes.


BACKGROUND
Current Controlled trials ISRCTN86769081.
MRC Epidemiology Unit, Addenbrooke's Hospital, Cambridge, UK. basile.echouffo-tcheugui@mrc-epid.cam.ac.uk
Justin B
JB
Echouffo-Tcheugui
Rebecca K
RK
Simmons
Kate M
KM
Williams
Roslyn S
RS
Barling
A Toby
AT
Prevost
Ann Louise
AL
Kinmonth
Nicholas J
NJ
Wareham
Simon J
SJ
Griffin
D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001241:Aspirin / Q000008:administration & dosage; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000191:economics / Q000628:therapy*; D042241:Early Diagnosis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D008403:Mass Screening / Q000191:economics / Q000379:methods; D008687:Metformin / Q000008:administration & dosage; D008875:Middle Aged; D049993:Sodium Chloride Symporter Inhibitors / Q000008:administration & dosage
D000893:Anti-Inflammatory Agents; D007004:Hypoglycemic Agents; D049993:Sodium Chloride Symporter Inhibitors; D008687:Metformin; D001241:Aspirin