Cardiovascular risk reduction following diagnosis of diabetes by screening: 1-year results from the ADDITION-Cambridge trial cohort.
BACKGROUND
Uncertainties persist concerning the effects of early intensive management of type 2 diabetes and which patients benefit most from such an approach.


OBJECTIVE
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.


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Section of General Practice, Department of Public Health, Faculty of Health Sciences, Aarhus University, Denmark.
Morten
M
Charles
Rebecca K
RK
Simmons
Kate M
KM
Williams
Gojka
G
Roglic
Stephen J
SJ
Sharp
Ann-Louise
AL
Kinmonth
Nicholas J
NJ
Wareham
Simon J
SJ
Griffin
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015992:Body Mass Index; D016000:Cluster Analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000517:prevention & control*; D003925:Diabetic Angiopathies / Q000097:blood / Q000517:prevention & control*; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006293:Health Promotion; D006801:Humans; D006937:Hypercholesterolemia / Q000517:prevention & control; D006973:Hypertension / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008019:Life Style; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D040242:Risk Reduction Behavior; D016037:Single-Blind Method; D012907:Smoking / Q000009:adverse effects; D055105:Waist Circumference
D000959:Antihypertensive Agents; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents