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

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.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Blood Glucose / metabolism
  • Blood Pressure / physiology
  • Cholesterol / blood
  • Computer Simulation
  • Critical Care
  • Denmark / epidemiology
  • Diabetes Mellitus, Type 2 / mortality
  • Diabetes Mellitus, Type 2 / prevention & control*
  • Diabetic Angiopathies / mortality
  • Diabetic Angiopathies / prevention & control*
  • Early Diagnosis
  • Female
  • Humans
  • Mass Screening / methods
  • Middle Aged
  • Netherlands / epidemiology
  • Primary Health Care
  • Risk Factors
  • United Kingdom / epidemiology

Substances

  • Blood Glucose
  • Cholesterol