Jeffrey Mahon, MD, MSc
Does a stepwise screening program for type 2 diabetes reduce mortality compared with no screening in high-risk persons?
Pragmatic, cluster-randomized, controlled trial (ADDITION-Cambridge trial). Current Controlled Trials ISRCTN86769081.
Blinded† (outcome assessors and data analysts).
Median 9.6 years.
33 general practices in eastern England, UK.
20 184 persons 40 to 69 years of age (mean age 58 y, 64% men) who were at high risk for undiagnosed diabetes (score ≥ 0.17 on a validated risk score calculated using data from electronic medical records: age, sex, body mass index, and prescriptions for steroid and antihypertensive medications). Exclusion criteria included life expectancy < 1 year, psychiatric illness affecting study participation, or pregnancy or lactation.
Stepwise screening followed by intensive treatment (n = 15 practices) or routine care (n = 13 practices) for persons with screen-detected diabetes (n = 16 047 participants for both screening groups combined), or no screening (n = 5 practices, n = 4137 participants). Stepwise screening included random capillary blood glucose and glycated hemoglobin (HbA1c) tests and, based on initial blood glucose levels, no further testing (no diabetes), fasting capillary blood glucose test and confirmatory oral glucose tolerance test (OGTT) if necessary, or an OGTT only.
Primary outcome was all-cause mortality. Secondary outcomes included cardiovascular (CV), cancer, and diabetes-related mortality.
99% of participants and 97% of practices (intention-to-screen analysis).
3% of persons in the screening groups were diagnosed with diabetes. Screening for type 2 diabetes did not reduce all-cause, CV, cancer, or diabetes-related mortality compared with no screening (Table).
A single screening for type 2 diabetes in high-risk persons did not reduce mortality over 10 years compared with no screening.
Screening vs no screening for type 2 diabetes in high-risk persons‡
‡Abbreviations defined in Glossary. RRI and CI calculated from event rates and hazard ratios (adjusted for clustering) in article.
Mahon J. A single screening for type 2 diabetes in high-risk adults did not reduce mortality over 10 years. Ann Intern Med. ;158:JC4. doi: 10.7326/0003-4819-158-2-201301150-02004
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Published: Ann Intern Med. 2013;158(2):JC4.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism, Prevention/Screening.
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