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Diabetes Care. 2015 Aug;38(8):1449-55. doi: 10.2337/dc14-2459. Epub 2015 May 18.

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).

Author information

1
Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, MI wherman@umich.edu.
2
School of Public Health, University of Michigan, Ann Arbor, MI.
3
Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, U.K.
4
Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, U.K.
5
Department of Primary Care, Julius Center, University Medical Center, Utrecht, the Netherlands.
6
Institute of Public Health, Section of General Practice, Aarhus University, Aarhus, Denmark.
7
Holbaek Hospital, Holbæk Sygehus, Holbaek, Denmark.

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.

RESEARCH DESIGN AND 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.

PMID:
25986661
PMCID:
PMC4512138
DOI:
10.2337/dc14-2459
[Indexed for MEDLINE]
Free PMC Article

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