title: Change in cardiovascular risk factors following early diagnosis of type 2 diabetes: a cohort analysis of a cluster-randomised trial.
abstract: BACKGROUND
  There is little evidence to inform the targeted treatment of individuals found early in the diabetes disease trajectory.
  
  
  OBJECTIVE
  To describe cardiovascular disease (CVD) risk profiles and treatment of individual CVD risk factors by modelled CVD risk at diagnosis; changes in treatment, modelled CVD risk, and CVD risk factors in the 5 years following diagnosis; and how these are patterned by socioeconomic status.
  
  
  METHODS
  Cohort analysis of a cluster-randomised trial (ADDITION-Europe) in general practices in Denmark, England, and the Netherlands.
  
  
  METHODS
  A total of 2418 individuals with screen-detected diabetes were divided into quartiles of modelled 10-year CVD risk at diagnosis. Changes in treatment, modelled CVD risk, and CVD risk factors were assessed at 5 years.
  
  
  RESULTS
  The largest reductions in risk factors and modelled CVD risk were seen in participants who were in the highest quartile of modelled risk at baseline, suggesting that treatment was offered appropriately. Participants in the lowest quartile of risk at baseline had very similar levels of modelled CVD risk at 5 years and showed the least variation in change in modelled risk. No association was found between socioeconomic status and changes in CVD risk factors, suggesting that treatment was equitable.
  
  
  CONCLUSIONS
  Diabetes management requires setting of individualised attainable targets. This analysis provides a reference point for patients, clinicians, and policymakers when considering goals for changes in risk factors early in the course of the disease that account for the diverse cardiometabolic profile present in individuals who are newly diagnosed with type 2 diabetes.
authors.affiliation: MRC Epidemiology Unit, Addenbrooke's Hospital, Cambridge.
authors.forename: James A
authors.initials: JA
authors.lastname: Black
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Sharp
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wareham
authors.forename: Annelli
authors.initials: A
authors.lastname: Sandbæk
authors.forename: Guy E H M
authors.initials: GE
authors.lastname: Rutten
authors.forename: Torsten
authors.initials: T
authors.lastname: Lauritzen
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Khunti
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: Davies
authors.forename: Knut
authors.initials: K
authors.lastname: Borch-Johnsen
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Griffin
authors.forename: Rebecca K
authors.initials: RK
authors.lastname: Simmons
mesh_terms: D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000097:blood / Q000517:prevention & control*; D008076:Cholesterol, HDL / Q000097:blood*; D016000:Cluster Analysis; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D003718:Denmark; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy*; D042241:Early Diagnosis; D004739:England; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D018570:Risk Assessment; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D011795:Surveys and Questionnaires; D014280:Triglycerides / Q000097:blood*
chemical_list: D015415:Biomarkers; D008076:Cholesterol, HDL; D003404:Creatinine; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D012709:Serum Albumin; D014280:Triglycerides
keywords: cardiovascular diseases; diabetes mellitus, type 2; prevention and control; primary health care; risk assessment; risk factors; treatment heterogeneity