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Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen Detected Diabetes in Primary Care

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Most people are diagnosed with diabetes when they develop symptoms or complications of the disease. However, there is growing evidence that earlier detection and treatment of diabetes may be of benefit. ADDITION-Cambridge is part of a multi-national trial (ADDITION-Europe) that aims to investigate the benefits of testing people for type 2 diabetes regardless of whether they show signs of the disease. This is a process known as screening.

People with type 2 diabetes have an increased risk of developing cardiovascular disease (heart disease, stroke and all other diseases of the heart and circulation). In the ADDITION study we are also looking at the effects of treating risk factors for cardiovascular disease following earlier diagnosis by screening. 

Screening study

Recruitment of participants and initial screening took place in 63 practices across the East Anglia region between January 2002 and March 2006. 33,539 individuals at increased risk of developing diabetes were invited for an initial finger-prick blood test; 24,654 (74%) people attended. Confirmation of the diagnosis of diabetes and baseline assessments were carried out in our clinical research facilities in Ely, Wisbech and Cambridge with additional measurements in Peterborough and Huntingdon. As a result of the screening programme 867 people in the East Anglia region were made aware that they had diabetes.

We also included GP practices in which patients were not invited for screening. These practices acted as a “control” group so that we can compare health outcomes between people who were invited to screening and those who were not to investigate whether screening is linked to health benefits.

Treatment study

Half of the patients diagnosed with type 2 diabetes in ADDITION-Cambridge went on to receive standard care for type 2 diabetes from their general practice following national guidelines. The other half received an intensive treatment programme to reduce their risk of cardiovascular disease. This treatment included:

  • educational materials designed to help patients to improve their diet, increase their physical activity and stop smoking.
  • increased use of medication to reduce levels of cardiovascular risk factors such as blood glucose, blood pressure and cholesterol.

We invited the two groups of patients back to our testing sites for a health assessment after one and five years. We compared the two groups to assess whether the intensive treatment programme reduced the risk of developing cardiovascular disease and which approach patients preferred.

A detailed explanation of the study can be found here.

What have we found?

  • Screening for diabetes does not make people feel anxious, depressed or falsely reassured.
  • The health status of ADDITION-Cambridge participants was improved five years after diagnosis e.g. there were important reductions in levels of blood pressure, cholesterol and blood glucose over the five years of the study.
  • Earlier diagnosis and treatment of diabetes has contributed to lower than expected rates of heart attacks and premature death, which are now similar to those in the general population without diabetes.

This study is conducted in collaboration with the University of Cambridge General Practice and Primary Care Research Unit (GPPCRU).

ADDITION Plus

ADDITION plus is a sub-study that involves patients within the intensive treatment programme of the ADDITION study and patients with diabetes recently diagnosed by their GP. In addition to their treatment programme, half of the patients were given additional support and advice aimed to help them keep to their programme of lifestyle changes and medication.  The other half of the patients were not given any additional support. Behaviour change in each group was then measured after one year and five years.

A detailed explanation of the study can be found here.

This sub-study is funded by an MRC project grant held in University of Cambridge General Practice and Primary Care Research Unit (GPPCRU).

ADDITION Europe 5 year follow-up

In collaboration with colleagues in Denmark and the Netherlands, data from the treatment study of ADDITION allowed analysis of the impact of the intensive treatment programme on cardiovascular outcomes after 5 years. This study recruited 3,057 people with screen-detected diabetes. Study results were recently published in the Lancet medical journal, which can be found here.

For more information about the ADDITION-Europe trial, visit the website www.addition.au.dk