title: Early Detection and Treatment of Type 2 Diabetes Reduce Cardiovascular Morbidity and Mortality: A Simulation of the Results of the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen-Detected Diabetes in Primary Care (ADDITION-Europe).
abstract: OBJECTIVE
  To estimate the benefits of screening and early treatment of type 2 diabetes compared with no screening and late treatment using a simulation model with data from the ADDITION-Europe study.
  
  
  METHODS
  We used the Michigan Model, a validated computer simulation model, and data from the ADDITION-Europe study to estimate the absolute risk of cardiovascular outcomes and the relative risk reduction associated with screening and intensive treatment, screening and routine treatment, and no screening with a 3- or 6-year delay in the diagnosis and routine treatment of diabetes and cardiovascular risk factors.
  
  
  RESULTS
  When the computer simulation model was programmed with the baseline demographic and clinical characteristics of the ADDITION-Europe population, it accurately predicted the empiric results of the trial. The simulated absolute risk reduction and relative risk reduction were substantially greater at 5 years with screening, early diagnosis, and routine treatment compared with scenarios in which there was a 3-year (3.3% absolute risk reduction [ARR], 29% relative risk reduction [RRR]) or a 6-year (4.9% ARR, 38% RRR) delay in diagnosis and routine treatment of diabetes and cardiovascular risk factors.
  
  
  CONCLUSIONS
  Major benefits are likely to accrue from the early diagnosis and treatment of glycemia and cardiovascular risk factors in type 2 diabetes. The intensity of glucose, blood pressure, and cholesterol treatment after diagnosis is less important than the time of its initiation. Screening for type 2 diabetes to reduce the lead time between diabetes onset and clinical diagnosis and to allow for prompt multifactorial treatment is warranted.
authors.affiliation: Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, MI wherman@umich.edu.
authors.forename: William H
authors.initials: WH
authors.lastname: Herman
authors.affiliation: School of Public Health, University of Michigan, Ann Arbor, MI.
authors.forename: Wen
authors.initials: W
authors.lastname: Ye
authors.affiliation: Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, U.K.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Griffin
authors.affiliation: Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, U.K.
authors.forename: Rebecca K
authors.initials: RK
authors.lastname: Simmons
authors.affiliation: Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, U.K.
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: Davies
authors.affiliation: Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, U.K.
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Khunti
authors.affiliation: Department of Primary Care, Julius Center, University Medical Center, Utrecht, the Netherlands.
authors.forename: Guy E H M
authors.initials: GE
authors.lastname: Rutten
authors.affiliation: Institute of Public Health, Section of General Practice, Aarhus University, Aarhus, Denmark.
authors.forename: Annelli
authors.initials: A
authors.lastname: Sandbaek
authors.affiliation: Institute of Public Health, Section of General Practice, Aarhus University, Aarhus, Denmark.
authors.forename: Torsten
authors.initials: T
authors.lastname: Lauritzen
authors.affiliation: Holbaek Hospital, Holbæk Sygehus, Holbaek, Denmark.
authors.forename: Knut
authors.initials: K
authors.lastname: Borch-Johnsen
authors.affiliation: School of Public Health, University of Michigan, Ann Arbor, MI.
authors.forename: Morton B
authors.initials: MB
authors.lastname: Brown
authors.affiliation: Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, U.K.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wareham
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D002784:Cholesterol / Q000097:blood; D003198:Computer Simulation; D003422:Critical Care; D003718:Denmark / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality / Q000517:prevention & control*; D003925:Diabetic Angiopathies / Q000401:mortality / Q000517:prevention & control*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011320:Primary Health Care; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D002784:Cholesterol