C. Raina Elley, MD; Tim Kenealy, MD, PhD
In patients with screen-detected type 2 diabetes, does an intensive, multifactorial primary care treatment strategy reduce cardiovascular (CV) risk factors more than routine care?
Cluster-randomized, controlled trial (preliminary analysis of the Dutch part of the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care [ADDITION]). ClinicalTrials.gov NCT00237549.
Blinded (patients and data collectors).*
79 general practices in the Netherlands.
498 patients 50 to 70 years of age (mean age 60 y, 54% men) who were newly diagnosed with type 2 diabetes by a 2-stage screening process. Patients with psychiatric or cognitive disorders, current treatment for cancer, or a poor prognosis were excluded.
Intensive treatment, including special physician training and frequent follow-up by a diabetes nurse, to lower glucose levels (target hemoglobin [Hb] A1c level ≤ 7.0%), blood pressure (BP, target ≤ 120/80 mm Hg), and lipid levels (target total cholesterol level <3.5 mmol/L for all patients) combined with structured lifestyle education (37 practices, 255 patients); or routine care according to national guidelines (42 practices, 243 patients).
Changes in body mass index, BP, HbA1c level, and serum lipid levels; and health-related quality of life (Short Form 36).
99% (intention-to-treat analysis).
Patients in the intensive treatment group had greater decreases in most CV risk factors than did those in the routine care group (Table). At 1 year, groups did not differ for health-related quality of life; both groups showed improvements in general health, vitality, and mental health.
In patients with screen-detected type 2 diabetes, an intensive, multifactorial, primary care treatment strategy reduced cardiovascular risk factors more than routine care.
Intensive multifactorial treatment vs routine care in patients with screen-detected type 2 diabetes‡
‡BP = blood pressure; HDL = high-density-lipoprotein; LDL = low-density-lipoprotein. Data are change in mean values from baseline to 1 year, calculated from data in article.
§Adjusted for age, sex, baseline value, and clustering.
Elley CR, Kenealy T. Intensive primary care treatment reduced cardiovascular risk factors at 1 year in screen-detected type 2 diabetes. Ann Intern Med. ;150:JC5–9. doi: 10.7326/0003-4819-150-10-200905190-02009
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Published: Ann Intern Med. 2009;150(10):JC5-9.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism, Prevention/Screening.
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