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Value of Intensive Treatment for Early Diabetes Questioned

When early type 2 diabetes is detected by screening, intensive management doesn’t seem to cut the risk of certain complications later on, a Danish study indicates.

The authors reported, “We found no statistically significant effect of intensive multifactorial treatment on the prevalence of diabetic peripheral neuropathy and peripheral arterial disease compared with routine care.”

Dr. Morten Charles, with the School of Public Health, Aarhus University, and colleagues point out that screening for diabetes is increasingly accepted, but its value is uncertain.

Earlier this year in The Lancet, some of Dr. Charles’ co-authors on this paper were among those reporting on the international ADDITION study, in which intensive management of screen-detected type 2 diabetes yielded a nonsignificant reduction in cardiovascular events over five years.

The current study focused on 1,533 Danish participants in ADDITION. They were managed in general practices that were randomized to deliver either intensive multifactorial treatment or routine care.

Six years after screening, the prevalence of an ankle-brachial index of 0.9 or less was 9.1% in the routine-care arm and 7.3% in the intensive treatment arm. Similarly, abnormal test results for neuropathy were seen in 34.8% and 30.1% in the routine- and intensive-treatment groups, respectively.

Dr. Charles and colleagues commented that, while these differences were not statistically significant, “all observed risk estimates favored multifactorial intervention at a nonstatistically significant level.” They also point out that the prevalence of peripheral neuropathy and peripheral arterial disease were high, so “clinicians should be aware of these high prevalences when dealing with patients with screen-detected diabetes.”

The researchers offered another caveat: “It is conceivable” that when diabetes is in its initial stages, “a longer duration of intensive treatment is necessary to observe an effect.”

They added, “A future repeated examination of our participants after a longer follow-up period will show whether this is the case.”

Diabetes Care Aug. 4, 2011.