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Intensive versus standard multifactorial cardiovascular risk factor control in screen-detected type 2 diabetes: 5 year and longer-term modelled outcomes of the ADDITION-Leicester study

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posted on 2019-02-22, 14:50 authored by D Webb, J Dales, F Zaccardi, S Hill, C Moore, A Farooqi, S Griffin, M Davies, K Khunti
AIMS: Diabetes treatment algorithms recommend intensive intervention in those with a shorter duration of disease. Screening provides opportunities for earlier multifactorial cardiovascular risk factor control. Using data from the ADDITION-Leicester study (NCT00318032), we estimated the effects of this approach on modelled risk of diabetes related complications in screen-detected patients. METHODS: 345(41% South Asian) people with screen-detected type 2 diabetes were cluster randomised to receive 5-years of 1)intensive multifactorial risk factor intervention or 2)standard treatment according to national guidance. Estimated 10-20 year risk of ischaemic heart disease, stroke, congestive cardiac failure and death were calculated using UK-PDS risk equations. RESULTS: Compared to standard care, mean treatment differences for intensive management at 5 years were; -11.7(95%CI:-15.0,-8.4) and -6.6(-8.8,-4.4) mmHg for systolic and diastolic blood pressure, respectively; -0.27 (-0.66, -0.26) % for HbA1c; and -0.46(-0.66; -0.26), -0.34 (-0.51; -0.18), and -0.19 (-0.28; -0.10) mmol/l for total cholesterol, LDL-cholesterol, and triglycerides, respectively. There was no significant weight gain in the intensive group despite additional medication use. Modelled risks were consistently lower for intensively managed patients. Absolute risk reduction associated with intensive treatment at 10 and 20 years were 3.5% and 6.2% for ischaemic heart disease and 6.3% and 8.8% for stroke. Risk reduction for congestive heart failure plateaued after 15 years at 5.3%. No differences were observed for blindness and all-cause death. CONCLUSION: Intensive multifactorial intervention in a multi-ethnic population with screen-detected type 2 diabetes results in sustained improvements in modelled ischaemic heart disease, stroke and congestive cardiac failure.

Funding

ADDITION‐Leicester was supported by the Department of Health and Support for Sciences, the NIHR Health Technology Assessment Programme (grant reference no: 08/116/300), National Health Service research and development support funding (including the Primary Care Research and Diabetes Research Networks Leicestershire, Northamptonshire and Rutland Collaborative for Leadership in Applied Health Research and Care), and the NIHR Leicester Biomedical Research Centre.

History

Citation

Diabetes Metab Res Rev, 2018, pp. e3111-?

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Diabetes Research Centre

Version

  • AM (Accepted Manuscript)

Published in

Diabetes Metab Res Rev

Publisher

Wiley

eissn

1520-7560

Acceptance date

2018-10-30

Copyright date

2018

Publisher version

https://onlinelibrary.wiley.com/doi/full/10.1002/dmrr.3111

Notes

The file associated with this record is under embargo until 12 months after publication, in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above.

Language

en

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