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Title: Does early intensive multifactorial therapy reduce modelled cardiovascular risk in individuals with screen-detected diabetes? Results from the ADDITION-Europe cluster randomized trial
Authors: Black, J. A.
Sharp, S. J.
Wareham, N. J.
Sandbaek, A.
Rutten, G. E. H. M.
Lauritzen, T.
Khunti, Kamlesh
Davies, Melanie J.
Borch-Johnsen, K.
Griffin, S. J.
Simmons, R. K.
First Published: 1-Jun-2014
Publisher: Wiley for Diabetes UK
Citation: Diabetic Medicine, 2014, 31 (6), pp. 647-656 (10)
Abstract: Aims: Little is known about the long-term effects of intensive multifactorial treatment early in the diabetes disease trajectory. In the absence of long-term data on hard outcomes, we described change in 10-year modelled cardiovascular risk in the 5 years following diagnosis, and quantified the impact of intensive treatment on 10-year modelled cardiovascular risk at 5 years. Methods: In a pragmatic, cluster-randomized, parallel-group trial in Denmark, the Netherlands and the UK, 3057 people with screen-detected Type 2 diabetes were randomized by general practice to receive (1) routine care of diabetes according to national guidelines (1379 patients) or (2) intensive multifactorial target-driven management (1678 patients). Ten-year modelled cardiovascular disease risk was calculated at baseline and 5 years using the UK Prospective Diabetes Study Risk Engine (version 3β). Results: Among 2101 individuals with complete data at follow up (73.4%), 10-year modelled cardiovascular disease risk was 27.3% (sd 13.9) at baseline and 21.3% (sd 13.8) at 5-year follow-up (intensive treatment group difference –6.9, sd 9.0; routine care group difference –5.0, sd 12.2). Modelled 10-year cardiovascular disease risk was lower in the intensive treatment group compared with the routine care group at 5 years, after adjustment for baseline cardiovascular disease risk and clustering (–2.0; 95% CI –3.1 to –0.9). Conclusions: Despite increasing age and diabetes duration, there was a decline in modelled cardiovascular disease risk in the 5 years following diagnosis. Compared with routine care, 10-year modelled cardiovascular disease risk was lower in the intensive treatment group at 5 years. Our results suggest that patients benefit from intensive treatment early in the diabetes disease trajectory, where the rate of cardiovascular disease risk progression may be slowed.
DOI Link: 10.1111/dme.12410
ISSN: 0742-3071
eISSN: 1464-5491
Version: Publisher Version
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © 2014 The Authors. Diabetic Medicine © 2014 Diabetes UK. Published under the OnlineOpen model.
Appears in Collections:Published Articles, Dept. of Health Sciences
Published Articles, Dept. of Cardiovascular Sciences

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