The Importance of Early Detection and Treatment of Type 2 DiabetesCreated by:
A research that combined large scale clinical observations and innovative computer modelling has showed that screening to identify type 2 diabetes followed by early treatment could result in substantial health benefits.
Researchers at the University of Michigan and the MRC Epidemiology Unit, University of Cambridge, used data from the ADDITION-Europe study of diabetes screening and treatment, which it combined with a computer simulation model of diabetes progression. This revealed that screening followed by treatment led to a reduced risk of cardiovascular disease or death within a 5-year follow-up period when compared to patients having no screening.
The ADDITION-Europe study included people between 40-69 years old without known diabetes from 343 general practices in the United Kingdom, Denmark, and the Netherlands. The study had two objectives: firstly, to determine if routine screening for type 2 diabetes was feasible; secondly, to determine if early, intensive, treatment of high blood sugar and cardiovascular risk factors such as blood pressure, cholesterol status and smoking in those diagnosed with type 2 diabetes reduced the risk of events such as stroke, heart attack, angioplasty, heart bypass surgery, amputation and death.
In order to assess the impact of a delay in diagnosis and treatment for type 2 diabetes, the researchers simulated scenarios where screening did not take place and there was either a three-year or six-year delay before diagnosis, after which routine care was initiated.
At 10 years after baseline, the simulations predicted that with a delay of 3 years in diagnosis and treatment 22.4 % of those with type 2 diabetes would experience a cardiovascular disease event, such as stroke or heart bypass surgery, which rose to 25.9% with a delay of six years. However, if screening and routine care had been implemented, the simulation predicted only 18.4% would experience a cardiovascular disease event at 10 years after baseline. The simulated incidence of all-cause mortality was 16.4% with a delay of three years and 18.2% with a delay of six years, compared to 14.6% for screening and treatment.
In other words, over 10 years, the model expects that for people with undescovered type 2 diabetes, screening would be associated with a 29% reduction in relative risk of a cardiovascular disease event compared with a delay of six years in diagnosis and treatment. This amounts to a 7.5% reduction in the absolute risk of adverse cardiovascular outcome in this population. The comparable change in all-cause mortality was 20% relative risk and 3.6% absolute risk reduction.
“ADDITION-Europe is a large, high quality study, but even so there are limitations in how much direct clinical observation can tell us about the costs and benefits of screening. Computer simulations add an extra dimension which we hope will guide future research as well as the development of public health policy.” Professor Nick Wareham says.