Stepwise screening for diabetes identifies people with high but modifiable coronary heart disease risk. The ADDITION study
Stepwise screening for diabetes identifies people with high but modifiable coronary heart disease risk. The ADDITION study
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DOI：
10.1007/s00125-008-1013-0
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发表时间：
2008-07-01
期刊：
影响因子：
8.2
通讯作者：
Lauritzen, T.
中科院分区：
文献类型：
--
作者：
Sandbaek, A.;Griffin, S. J.;Lauritzen, T.
目的/假设英国-丹麦-荷兰在初级保健中对筛查发现的糖尿病患者进行强化治疗的研究（ADDITION）是一项实用的随机对照试验，旨在评价强化多因素治疗对荷兰、英国和丹麦筛查发现的2型糖尿病患者5年心血管发病率和死亡率的有效性。本文介绍了研究人群的基线特征，他们估计的冠心病的风险和程度，这种风险是潜在modifiable.Methods逐步筛选策略进行风险问卷调查和常规的一般做法的数据，加上随机血糖，HbA（1C）和空腹血糖测量。糖尿病的诊断采用1999年世界卫生组织的标准，估计10年冠心病的风险计算采用英国前瞻性糖尿病研究的风险engine.Results之间2001年4月和2006年12月，3,057人与屏幕检测糖尿病被招募到这项研究（平均年龄59.7岁，58%为男性），在三个国家的334个全科诊所对76，308人进行了逐步筛查。女性10年冠心病风险的中位数估计为11%（四分位数范围7-16%），男性为21%（15-30%）。各国风险因素的分布情况不同，这与筛查方法不同以及风险因素已被发现和处理的程度不同有关。招募时的平均HbA（1c）为7.0%（SD 1.6%）。在招募的人中，73%的人血压>= 140/90，其中58%没有服用抗高血压药物。70%的参与者胆固醇水平高于5.0 mmol/l，其中91%的人没有接受降脂药物治疗。结论/解释通过筛查发现并纳入ADDITION研究的2型糖尿病患者的风险增加，并且可能是可改变的。CHD.ClinicalTrials.gov NCT 00237549。
Aims/hypothesis The Anglo-Danish-Dutch study of intensive treatment in people with screen-detected diabetes in primary care (ADDITION) is a pragmatic randomised controlled trial of the effectiveness of intensified multi-factorial treatment on 5 year cardiovascular morbidity and mortality rates in people with screen-detected type 2 diabetes in the Netherlands, UK and Denmark. This paper describes the baseline characteristics of the study population, their estimated risk of coronary heart disease and the extent to which that risk is potentially modifiable.Methods Stepwise screening strategies were performed using risk questionnaires and routine general practice data plus random blood glucose, HbA(1c) and fasting blood glucose measurement. Diabetes was diagnosed using the 1999 World Health Organization criteria and estimated 10 year coronary heart disease risk was calculated using the UK Prospective Diabetes Study risk engine.Results Between April 2001 and December 2006, 3,057 people with screen-detected diabetes were recruited to the study (mean age 59.7 years, 58% men) after a stepwise screening programme involving 76,308 people screened in 334 general practices in three countries. Their median estimated 10 year risk of coronary heart disease was 11% in women (interquartile range 7-16%) and 21% (15-30%) in men. There were differences in the distribution of risk factors by country, linked to differences in approaches to screening and the extent to which risk factors had already been detected and treated. The mean HbA(1c) at recruitment was 7.0% (SD 1.6%). Of the people recruited, 73% had a blood pressure >= 140/90 and of these 58% were not on antihypertensive medication. Cholesterol levels were above 5.0 mmol/l in 70% of participants, 91% of whom were not being treated with lipid-lowering drugs.Conclusions/interpretation People with type 2 diabetes detected by screening and included in the ADDITION study have a raised and potentially modifiable risk of CHD.ClinicalTrials.gov ID no.: NCT 00237549.