Obesity 1-9

Screening for type 2 diabetes and population mortality over 10 years (ADDITION-Cambridge): a cluster-randomised controlled trial

R. K. Simmons, J. B. Echouffo-Tcheugui, S. J. Sharp, L. A. Sargeant, K. M. Williams, A. T. Prevost, A. L. Kinmonth, N. J. Wareham and S. J. Griffin

Lancet.2012 Nov;380(9855):1741-1748.

Abstract: Background The increasing prevalence of type 2 diabetes poses a major public health challenge. Population-based screening and early treatment for type 2 diabetes could reduce this growing burden. However, uncertainty persists around the benefits of screening for type 2 diabetes. We assessed the effect of a population-based stepwise screening programme on mortality. Methods In a pragmatic parallel group, cluster-randomised trial, 33 general practices in eastern England were randomly assigned by the method of minimisation in an unbalanced design to: screening followed by intensive multifactorial treatment for people diagnosed with diabetes (n=15); screening plus routine care of diabetes according to national guidelines (n=13); and a no-screening control group (n=5). The study population consisted of 20 184 individuals aged 40-69 years (mean 58 years), at high risk of prevalent undiagnosed diabetes, on the basis of a previously validated risk score. In screening practices, individuals were invited to a stepwise programme including random capillary blood glucose and glycated haemoglobin (HbA(1c)) tests, a fasting capillary blood glucose test, and a confirmatory oral glucose tolerance test. The primary outcome was all-cause mortality. All participants were flagged for mortality surveillance by the England and Wales Office of National Statistics. Analysis was by intention-to-screen and compared all-cause mortality rates between screening and control groups. This study is registered, number ISRCTN86769081. Findings Of 16 047 high-risk individuals in screening practices, 15 089 (94%) were invited for screening during 2001-06, 11 737 (73%) attended, and 466 (3%) were diagnosed with diabetes. 4137 control individuals were followed up. During 184 057 person-years of follow up (median duration 9.6 years [IQR 8.9-9.9]), there were 1532 deaths in the screening practices and 377 in control practices (mortality hazard ratio [HR] 1.06, 95% CI 0.90-1.25). We noted no significant reduction in cardiovascular (HR 1.02, 95% CI 0.75-1.38), cancer (1.08, 0.90-1.30), or diabetes-related mortality (1.26, 0.75-2.10) associated with invitation to screening. Interpretation In this large UK sample, screening for type 2 diabetes in patients at increased risk was not associated with a reduction in all-cause, cardiovascular, or diabetes-related mortality within 10 years. The benefits of screening might be smaller than expected and restricted to individuals with detectable disease.

*Times cited: 4

Keywords: coronary-heart-disease, follow-up, cancer mortality, general-practice, glucose control, ely cohort, risk, complications, people, programs

Link: http://www.ncbi.nlm.nih.gov/pubmed/23040422

Multiselect Ultimate Query Plugin by InoPlugs Web Design Vienna | Webdesign Wien and Juwelier SchönmannMultiselect Ultimate Query Plugin by InoPlugs Web Design Vienna | Webdesign Wien and Juwelier Schönmann