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Title: 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
Authors: Webb, D
Dales, J
Zaccardi, F
Hill, S
Moore, C
Farooqi, A
Griffin, S
Davies, M
Khunti, K
First Published: 6-Dec-2018
Publisher: Wiley
Citation: Diabetes Metab Res Rev, 2018, pp. e3111-?
Abstract: 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.
DOI Link: 10.1002/dmrr.3111
eISSN: 1520-7560
Embargo on file until: 6-Dec-2019
Version: Post-print
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © 2018 John Wiley & Sons, Ltd. Deposited with reference to the publisher’s open access archiving policy. (
Description: 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.
Appears in Collections:Published Articles, College of Medicine, Biological Sciences and Psychology

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