Early detection and treatment of type 2 diabetes may be more beneficial than aggressive control of blood glucose, blood pressure and cholesterol…
Screening to identify type 2 diabetes followed by early treatment could result in substantial health benefits, according to new research that combined large scale clinical observations and innovative computer modelling.
The study, led by researchers at the University of Michigan Medical School 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 approach revealed that screening followed by treatment led to a reduced risk of cardiovascular disease or death within a five-year follow-up period when compared to patients having no screening.
“Diabetes can be debilitating for patients and costly for healthcare,” says William Herman, M.D., lead author of the paper and a professor at the University of Michigan Medical School. “This research shows that the early identification of diabetes has major health benefits, and supports the introduction of measures such as screening to reduce the time between development of Type 2 diabetes and its treatment.”
Professor Nick Wareham, senior author on the paper and director of the MRC Epidemiology Unit, University of Cambridge, added: “This work shows the value of public health modelling to assess impacts and interventions for diseases such as type 2 diabetes that pose an increasing public health challenge.
At 10 years after baseline, the simulations predicted that with a delay of 3 years in diagnosis and treatment, 22.4 percent of those with type 2 diabetes would experience a cardiovascular disease event, such as stroke or heart bypass surgery. This rose to 25.9 percent with a diagnosis delay of six years.
However, if screening and routine care had been implemented, the simulation predicted only 18.4 percent would experience a cardiovascular disease event at 10 years after baseline. The simulated incidence of all-cause mortality was 16.4 percent with a delay of three years and 18.2 percent with a delay of six years, compared to 14.6 percent for screening and treatment.
This means that over 10 years, the model predicts that for people with undiagnosed type 2 diabetes, screening would be associated with a 29 percent 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 percent reduction in the absolute risk of adverse cardiovascular outcome in this population. The comparable change in all-cause mortality was 20 percent relative risk and 3.6 percent absolute risk reduction.
A validated simulation model called Michigan Model was used to simulate data obtained from an Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION-Europe). According to Herman, “The Michigan Model for type 2 diabetes simulates the progression of diabetes and its complications, comorbidities, quality of life and costs.” The end results were to estimate the absolute risk reduction (ARR) and relative risk reduction (RRR) of cardiovascular diseases in four different scenarios: 1) intensive treatment group; 2) routine care group; 3) a 3-year delay in diagnosis followed by routine care group and 4) a 6-year delay in diagnosis followed by routine care group.
Based on the results, absolute/relative risk reduction (ARR/RRR) of early diagnosis and routine care were substantially higher than delayed diagnosis and treatment. At 5 years estimation, ARR and RRR were 3.3% and 29% respectively when compared to 3-year delay group, there was 4.9%ARR and 38% RRR when compared to 6-year delay group.
Herman and his team concluded that there are substantial health benefits of early identification of type 2 diabetes.
- Early diagnosis and proper treatment of type 2 diabetes are likely to confer health benefits.
- Aggressive control of blood glucose, blood pressure and cholesterol after diagnosis of type 2 diabetes may be less important than early screening.
- Delaying in screening and treatment for type 2 diabetes may hasten and/or increase the risk for developing cardiovascular diseases.
William H. Herman. 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 (ADDITION-Europe). Published online before print May 18, 2015, doi: 10.2337/dc14-2459. Diabetes Care May 18, 2015.