Abstract
BackgroundThere is little evidence to inform the targeted treatment of individuals found early in the diabetes disease trajectory.AimTo describe cardiovascular disease (CVD) risk profiles and treatment of individual CVD risk factors by modelled CVD risk at diagnosis; changes in treatment, modelled CVD risk, and CVD risk factors in the 5 years following diagnosis; and how these are patterned by socioeconomic status.Design and settingCohort analysis of a cluster-randomised trial (ADDITION-Europe) in general practices in Denmark, England, and the Netherlands.MethodA total of 2418 individuals with screen-detected diabetes were divided into quartiles of modelled 10-year CVD risk at diagnosis. Changes in treatment, modelled CVD risk, and CVD risk factors were assessed at 5 years.ResultsThe largest reductions in risk factors and modelled CVD risk were seen in participants who were in the highest quartile of modelled risk at baseline, suggesting that treatment was offered appropriately. Participants in the lowest quartile of risk at baseline had very similar levels of modelled CVD risk at 5 years and showed the least variation in change in modelled risk. No association was found between socioeconomic status and changes in CVD risk factors, suggesting that treatment was equitable.ConclusionDiabetes management requires setting of individualised attainable targets. This analysis provides a reference point for patients, clinicians, and policymakers when considering goals for changes in risk factors early in the course of the disease that account for the diverse cardiometabolic profile present in individuals who are newly diagnosed with type 2 diabetes.
Highlights
The promotion of opportunistic screening for diabetes,[1] coupled with the assessment of diabetes risk in national health checks programmes,[2] will lead to a greater number of individuals being diagnosed early in the disease trajectory
Diabetes management requires setting of individualised attainable targets. This analysis provides a reference point for patients, clinicians, and policymakers when considering goals for changes in risk factors early in the course of the disease that account for the diverse cardiometabolic profile present in individuals who are newly diagnosed with type 2 diabetes
To inform the development and implementation of treatment policies in this high-risk group, this study aimed to examine baseline cardiovascular disease (CVD) risk profiles and treatment of CVD risk factors; change in treatment, modelled CVD risk, and CVD risk factors; and (iii) how these are patterned by socioeconomic status
Summary
The promotion of opportunistic screening for diabetes,[1] coupled with the assessment of diabetes risk in national health checks programmes,[2] will lead to a greater number of individuals being diagnosed early in the disease trajectory Among those with established diabetes, the risk of cardiovascular disease (CVD) and mortality can be reduced by intensive treatment of single risk factors, including blood pressure, cholesterol, and glucose.[3,4,5,6] Further, a small (n = 160) trial of multifactorial treatment found a protective effect at 13 years.[7] Screen-detected populations have a CVD risk profile that is distinct from that of individuals with clinically diagnosed or established diabetes,[8,9] and evidence to inform the treatment of individuals found earlier in the course of the disease, where CVD risk varies greatly,[8] is lacking. Input variables Age, sex, ethnicity, smoking status, glycated haemoglobin (HbA1c), systolic blood pressure, total:HDL (high density lipoprotein) cholesterol ratio, atrial fibrillation (AF), previous myocardial infarction or stroke, microalbuminuria (albumin:creatinine ratio ≥2.5 mg/mmol in males, or ≥3.5 mg/mmol in females), macroalbuminuria (albumin:creatinine ratio ≥30 mg/mmol), duration of diagnosed diabetes, and body mass index
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