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Screening for type 2 diabetes and population mortality over 10 years (ADDITION-Cambridge): a cluster-randomised controlled trial

Summary Background The increasing prevalence of type 2 diabetes poses a major public health challenge. Population-based screening and early treatment for type 2 diabetes could reduce this growing burden. However, uncertainty persists around the benefits of screening for type 2 diabetes. We assessed... Full description

Journal Title: The Lancet (British edition) 2012, Vol.380 (9855), p.1741-1748
Main Author: Simmons, Rebecca K, PhD
Other Authors: Echouffo-Tcheugui, Justin B, PhD , Sharp, Stephen J, MSc , Sargeant, Lincoln A, PhD , Williams, Kate M, PhD , Prevost, A Toby, Prof , Kinmonth, Ann Louise, Prof , Wareham, Nicholas J, Prof , Griffin, Simon J, Dr
Format: Electronic Article Electronic Article
Language: English
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R&D
Quelle: Alma/SFX Local Collection
Publisher: Kidlington: Elsevier Ltd
ID: ISSN: 0140-6736
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title: Screening for type 2 diabetes and population mortality over 10 years (ADDITION-Cambridge): a cluster-randomised controlled trial
format: Article
creator:
  • Simmons, Rebecca K, PhD
  • Echouffo-Tcheugui, Justin B, PhD
  • Sharp, Stephen J, MSc
  • Sargeant, Lincoln A, PhD
  • Williams, Kate M, PhD
  • Prevost, A Toby, Prof
  • Kinmonth, Ann Louise, Prof
  • Wareham, Nicholas J, Prof
  • Griffin, Simon J, Dr
subjects:
  • Adult
  • Aged
  • Biological and medical sciences
  • Biomedical research
  • Blood Glucose - analysis
  • Cardiovascular Diseases - complications
  • Cardiovascular Diseases - mortality
  • Care and treatment
  • Cluster Analysis
  • Databases
  • Diabetes
  • Diabetes Mellitus, Type 2 - complications
  • Diabetes Mellitus, Type 2 - diagnosis
  • Diabetes Mellitus, Type 2 - mortality
  • Diabetes. Impaired glucose tolerance
  • Diagnosis
  • Endocrine pancreas. Apud cells (diseases)
  • Endocrinopathies
  • England - epidemiology
  • Epidemiology
  • Etiopathogenesis. Screening. Investigations. Target tissue resistance
  • Female
  • Follow-Up Studies
  • General aspects
  • Glucose Tolerance Test
  • Glycated Hemoglobin A - analysis
  • Heart attacks
  • Humans
  • Internal Medicine
  • Male
  • Mass Screening - methods
  • Medical sciences
  • Medical screening
  • Methods
  • Middle Aged
  • Mortality
  • Neoplasms - complications
  • Neoplasms - mortality
  • Prevention and actions
  • Public health. Hygiene
  • Public health. Hygiene-occupational medicine
  • R&D
  • Research & development
  • Risk assessment
  • Risk Factors
  • Trust departments
  • Type 2 diabetes
  • Usage
ispartof: The Lancet (British edition), 2012, Vol.380 (9855), p.1741-1748
description: Summary Background The increasing prevalence of type 2 diabetes poses a major public health challenge. Population-based screening and early treatment for type 2 diabetes could reduce this growing burden. However, uncertainty persists around the benefits of screening for type 2 diabetes. We assessed the effect of a population-based stepwise screening programme on mortality. Methods In a pragmatic parallel group, cluster-randomised trial, 33 general practices in eastern England were randomly assigned by the method of minimisation in an unbalanced design to: screening followed by intensive multifactorial treatment for people diagnosed with diabetes (n=15); screening plus routine care of diabetes according to national guidelines (n=13); and a no-screening control group (n=5). The study population consisted of 20 184 individuals aged 40–69 years (mean 58 years), at high risk of prevalent undiagnosed diabetes, on the basis of a previously validated risk score. In screening practices, individuals were invited to a stepwise programme including random capillary blood glucose and glycated haemoglobin (HbA1c ) tests, a fasting capillary blood glucose test, and a confirmatory oral glucose tolerance test. The primary outcome was all-cause mortality. All participants were flagged for mortality surveillance by the England and Wales Office of National Statistics. Analysis was by intention-to-screen and compared all-cause mortality rates between screening and control groups. This study is registered, number ISRCTN86769081. Findings Of 16 047 high-risk individuals in screening practices, 15 089 (94%) were invited for screening during 2001–06, 11 737 (73%) attended, and 466 (3%) were diagnosed with diabetes. 4137 control individuals were followed up. During 184 057 person-years of follow up (median duration 9·6 years [IQR 8·9–9·9]), there were 1532 deaths in the screening practices and 377 in control practices (mortality hazard ratio [HR] 1·06, 95% CI 0·90–1·25). We noted no significant reduction in cardiovascular (HR 1·02, 95% CI 0·75–1·38), cancer (1·08, 0·90–1·30), or diabetes-related mortality (1·26, 0·75–2·10) associated with invitation to screening. Interpretation In this large UK sample, screening for type 2 diabetes in patients at increased risk was not associated with a reduction in all-cause, cardiovascular, or diabetes-related mortality within 10 years. The benefits of screening might be smaller than expected and restricted to individuals with detectable disease.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
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titleScreening for type 2 diabetes and population mortality over 10 years (ADDITION-Cambridge): a cluster-randomised controlled trial
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creatorSimmons, Rebecca K, PhD ; Echouffo-Tcheugui, Justin B, PhD ; Sharp, Stephen J, MSc ; Sargeant, Lincoln A, PhD ; Williams, Kate M, PhD ; Prevost, A Toby, Prof ; Kinmonth, Ann Louise, Prof ; Wareham, Nicholas J, Prof ; Griffin, Simon J, Dr
creatorcontribSimmons, Rebecca K, PhD ; Echouffo-Tcheugui, Justin B, PhD ; Sharp, Stephen J, MSc ; Sargeant, Lincoln A, PhD ; Williams, Kate M, PhD ; Prevost, A Toby, Prof ; Kinmonth, Ann Louise, Prof ; Wareham, Nicholas J, Prof ; Griffin, Simon J, Dr
descriptionSummary Background The increasing prevalence of type 2 diabetes poses a major public health challenge. Population-based screening and early treatment for type 2 diabetes could reduce this growing burden. However, uncertainty persists around the benefits of screening for type 2 diabetes. We assessed the effect of a population-based stepwise screening programme on mortality. Methods In a pragmatic parallel group, cluster-randomised trial, 33 general practices in eastern England were randomly assigned by the method of minimisation in an unbalanced design to: screening followed by intensive multifactorial treatment for people diagnosed with diabetes (n=15); screening plus routine care of diabetes according to national guidelines (n=13); and a no-screening control group (n=5). The study population consisted of 20 184 individuals aged 40–69 years (mean 58 years), at high risk of prevalent undiagnosed diabetes, on the basis of a previously validated risk score. In screening practices, individuals were invited to a stepwise programme including random capillary blood glucose and glycated haemoglobin (HbA1c ) tests, a fasting capillary blood glucose test, and a confirmatory oral glucose tolerance test. The primary outcome was all-cause mortality. All participants were flagged for mortality surveillance by the England and Wales Office of National Statistics. Analysis was by intention-to-screen and compared all-cause mortality rates between screening and control groups. This study is registered, number ISRCTN86769081. Findings Of 16 047 high-risk individuals in screening practices, 15 089 (94%) were invited for screening during 2001–06, 11 737 (73%) attended, and 466 (3%) were diagnosed with diabetes. 4137 control individuals were followed up. During 184 057 person-years of follow up (median duration 9·6 years [IQR 8·9–9·9]), there were 1532 deaths in the screening practices and 377 in control practices (mortality hazard ratio [HR] 1·06, 95% CI 0·90–1·25). We noted no significant reduction in cardiovascular (HR 1·02, 95% CI 0·75–1·38), cancer (1·08, 0·90–1·30), or diabetes-related mortality (1·26, 0·75–2·10) associated with invitation to screening. Interpretation In this large UK sample, screening for type 2 diabetes in patients at increased risk was not associated with a reduction in all-cause, cardiovascular, or diabetes-related mortality within 10 years. The benefits of screening might be smaller than expected and restricted to individuals with detectable disease. Funding Wellcome Trust; UK Medical Research Council; National Health Service research and development support; UK National Institute for Health Research; University of Aarhus, Denmark; Bio-Rad.
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subjectAdult ; Aged ; Biological and medical sciences ; Biomedical research ; Blood Glucose - analysis ; Cardiovascular Diseases - complications ; Cardiovascular Diseases - mortality ; Care and treatment ; Cluster Analysis ; Databases ; Diabetes ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - diagnosis ; Diabetes Mellitus, Type 2 - mortality ; Diabetes. Impaired glucose tolerance ; Diagnosis ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; England - epidemiology ; Epidemiology ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Female ; Follow-Up Studies ; General aspects ; Glucose Tolerance Test ; Glycated Hemoglobin A - analysis ; Heart attacks ; Humans ; Internal Medicine ; Male ; Mass Screening - methods ; Medical sciences ; Medical screening ; Methods ; Middle Aged ; Mortality ; Neoplasms - complications ; Neoplasms - mortality ; Prevention and actions ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; R&D ; Research & development ; Risk assessment ; Risk Factors ; Trust departments ; Type 2 diabetes ; Usage
ispartofThe Lancet (British edition), 2012, Vol.380 (9855), p.1741-1748
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1Echouffo-Tcheugui, Justin B, PhD
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3Sargeant, Lincoln A, PhD
4Williams, Kate M, PhD
5Prevost, A Toby, Prof
6Kinmonth, Ann Louise, Prof
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0Screening for type 2 diabetes and population mortality over 10 years (ADDITION-Cambridge): a cluster-randomised controlled trial
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descriptionSummary Background The increasing prevalence of type 2 diabetes poses a major public health challenge. Population-based screening and early treatment for type 2 diabetes could reduce this growing burden. However, uncertainty persists around the benefits of screening for type 2 diabetes. We assessed the effect of a population-based stepwise screening programme on mortality. Methods In a pragmatic parallel group, cluster-randomised trial, 33 general practices in eastern England were randomly assigned by the method of minimisation in an unbalanced design to: screening followed by intensive multifactorial treatment for people diagnosed with diabetes (n=15); screening plus routine care of diabetes according to national guidelines (n=13); and a no-screening control group (n=5). The study population consisted of 20 184 individuals aged 40–69 years (mean 58 years), at high risk of prevalent undiagnosed diabetes, on the basis of a previously validated risk score. In screening practices, individuals were invited to a stepwise programme including random capillary blood glucose and glycated haemoglobin (HbA1c ) tests, a fasting capillary blood glucose test, and a confirmatory oral glucose tolerance test. The primary outcome was all-cause mortality. All participants were flagged for mortality surveillance by the England and Wales Office of National Statistics. Analysis was by intention-to-screen and compared all-cause mortality rates between screening and control groups. This study is registered, number ISRCTN86769081. Findings Of 16 047 high-risk individuals in screening practices, 15 089 (94%) were invited for screening during 2001–06, 11 737 (73%) attended, and 466 (3%) were diagnosed with diabetes. 4137 control individuals were followed up. During 184 057 person-years of follow up (median duration 9·6 years [IQR 8·9–9·9]), there were 1532 deaths in the screening practices and 377 in control practices (mortality hazard ratio [HR] 1·06, 95% CI 0·90–1·25). We noted no significant reduction in cardiovascular (HR 1·02, 95% CI 0·75–1·38), cancer (1·08, 0·90–1·30), or diabetes-related mortality (1·26, 0·75–2·10) associated with invitation to screening. Interpretation In this large UK sample, screening for type 2 diabetes in patients at increased risk was not associated with a reduction in all-cause, cardiovascular, or diabetes-related mortality within 10 years. The benefits of screening might be smaller than expected and restricted to individuals with detectable disease. Funding Wellcome Trust; UK Medical Research Council; National Health Service research and development support; UK National Institute for Health Research; University of Aarhus, Denmark; Bio-Rad.
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5Cardiovascular Diseases - complications
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7Care and treatment
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11Diabetes Mellitus, Type 2 - complications
12Diabetes Mellitus, Type 2 - diagnosis
13Diabetes Mellitus, Type 2 - mortality
14Diabetes. Impaired glucose tolerance
15Diagnosis
16Endocrine pancreas. Apud cells (diseases)
17Endocrinopathies
18England - epidemiology
19Epidemiology
20Etiopathogenesis. Screening. Investigations. Target tissue resistance
21Female
22Follow-Up Studies
23General aspects
24Glucose Tolerance Test
25Glycated Hemoglobin A - analysis
26Heart attacks
27Humans
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29Male
30Mass Screening - methods
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38Prevention and actions
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titleScreening for type 2 diabetes and population mortality over 10 years (ADDITION-Cambridge): a cluster-randomised controlled trial
authorSimmons, Rebecca K, PhD ; Echouffo-Tcheugui, Justin B, PhD ; Sharp, Stephen J, MSc ; Sargeant, Lincoln A, PhD ; Williams, Kate M, PhD ; Prevost, A Toby, Prof ; Kinmonth, Ann Louise, Prof ; Wareham, Nicholas J, Prof ; Griffin, Simon J, Dr
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abstractSummary Background The increasing prevalence of type 2 diabetes poses a major public health challenge. Population-based screening and early treatment for type 2 diabetes could reduce this growing burden. However, uncertainty persists around the benefits of screening for type 2 diabetes. We assessed the effect of a population-based stepwise screening programme on mortality. Methods In a pragmatic parallel group, cluster-randomised trial, 33 general practices in eastern England were randomly assigned by the method of minimisation in an unbalanced design to: screening followed by intensive multifactorial treatment for people diagnosed with diabetes (n=15); screening plus routine care of diabetes according to national guidelines (n=13); and a no-screening control group (n=5). The study population consisted of 20 184 individuals aged 40–69 years (mean 58 years), at high risk of prevalent undiagnosed diabetes, on the basis of a previously validated risk score. In screening practices, individuals were invited to a stepwise programme including random capillary blood glucose and glycated haemoglobin (HbA1c ) tests, a fasting capillary blood glucose test, and a confirmatory oral glucose tolerance test. The primary outcome was all-cause mortality. All participants were flagged for mortality surveillance by the England and Wales Office of National Statistics. Analysis was by intention-to-screen and compared all-cause mortality rates between screening and control groups. This study is registered, number ISRCTN86769081. Findings Of 16 047 high-risk individuals in screening practices, 15 089 (94%) were invited for screening during 2001–06, 11 737 (73%) attended, and 466 (3%) were diagnosed with diabetes. 4137 control individuals were followed up. During 184 057 person-years of follow up (median duration 9·6 years [IQR 8·9–9·9]), there were 1532 deaths in the screening practices and 377 in control practices (mortality hazard ratio [HR] 1·06, 95% CI 0·90–1·25). We noted no significant reduction in cardiovascular (HR 1·02, 95% CI 0·75–1·38), cancer (1·08, 0·90–1·30), or diabetes-related mortality (1·26, 0·75–2·10) associated with invitation to screening. Interpretation In this large UK sample, screening for type 2 diabetes in patients at increased risk was not associated with a reduction in all-cause, cardiovascular, or diabetes-related mortality within 10 years. The benefits of screening might be smaller than expected and restricted to individuals with detectable disease. Funding Wellcome Trust; UK Medical Research Council; National Health Service research and development support; UK National Institute for Health Research; University of Aarhus, Denmark; Bio-Rad.
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