Main findings

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; online May 2015 (ADDITION-Europe); DOI: 10.2337/dc14-2459 

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. 

Screening for diabetes: what do the results of the ADDITION trial mean for clinical practice?

Diabetes Manage. (2013) 3(5), 367–378         

  • In Denmark, only 20% of those with undiagnosed diabetes were identified by screening.
  • For each person with diabetes identified, another two at high risk of diabetes and six at high risk of cardiovascular disease were identified.
  • Screening for diabetes had limited short- and long-term adverse psychological impact on participants.
  • Cardiovascular risk factors (weight, blood pressure and cholesterol), including health-related behaviors (smoking), improved substantially following detection of diabetes by screening.
  • Small increases in treatment intensity of screen-detected patients were associated with a nonsignificant 17% reduction in risk of a first cardiovascular event.
  • Among people with screen-detected diabetes, all-cause mortality over 7 years was twice as high for those with HbA1c <6.0% compared with those with HbA1c ≥6.5% at screening. Those with HbA1c <6.0% were less intensively treated than those with HbA1c ≥6.5%. The latter group had an all‑cause mortality that was not significantly different from people with normal glucose tolerance and HbA1c <6.0% at screening, presumably due to more intensive treatment.
  • At the population level, invitation of high-risk individuals to screening was not associated with a reduction in all-cause or diabetes-related mortality over 10 years.
  • The ADDITION study provides further evidence of the net benefit associated with earlier detection and treatment of Type 2 diabetes. Rather than screening the population for diabetes, primary care teams should focus efforts on earlier detection and treatment of risk factors among those with diabetes, at high risk of diabetes and high risk of cardiovascular disease.

Effect of early intensive multifactorial therapy on 5-year cardiovascular outcomes in individuals with type 2 diabetes detected by screening (ADDITION-Europe): a cluster-randomised trial

Lancet 2011; 378: 156–67

 An intervention to promote early intensive management of patients with type 2 diabetes was associated with a small, non-significant reduction in the incidence of cardiovascular events and death.