Early Identification, Intensive Intervention for Diabetes Might Improve Cardiovascular Outcomes
SOURCE: Herman WH, et al. 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). Diabetes Care 2015;38:1449-1455.
The ADDITION-Europe trial (Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care) enrolled adults (n = 120) whose diabetes had been detected through screening, and compared early intensive treatment (glucose, lipids, blood pressure, lifestyle) vs usual care. At the end of 5.3 years, there was a trend toward reduced cardiovascular (CV) outcomes that was not statistically significant. Nonetheless, these results were so encouraging that Herman et al performed a simulation model in which they compared potential outcomes in a much larger population extrapolated from the ADDITION-Europe trial data, as well as looked at a comparison population that was not screened (among whom one would anticipate significant delay in diagnosis and treatment).
When comparing usual care to intensive intervention, more subjects in the intensive intervention group were treated with statins, beta-blockers, and aspirin, and fewer persons smoked. When these same metrics were plugged into the Michigan Model for Type 2 Diabetes, and the potential number of participants substantially increased (to 6815), early detection through screening and intensive treatment was associated with a 29% relative risk reduction in CV events compared to an unscreened population diagnosed 6 years later and receiving usual care.
To date, a reduction in CV mortality has not been demonstrated within the confines of a randomized, controlled trial of glucose treatment in diabetes. Multifactorial trials in which blood pressure, lipids, weight, exercise, and glucose are concomitantly addressed have produced favorable CV risk reduction, but it becomes difficult to ascertain which component(s) of the multipronged intervention is most responsible for the beneficial outcomes.
Multifactorial trials in which blood pressure, lipids, weight, exercise, and glucose are concomitantly addressed have produced favorable CV risk reduction, but it becomes difficult to ascertain which component(s) of the multipronged intervention is most responsible for the beneficial outcomes.
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