BACKGROUND: Uncertainties persist concerning the effects of early intensive management of type 2 diabetes and which patients benefit most from such an approach. AIM: To describe change in modelled cardiovascular risk in the 14 months following diagnosis, and to examine which baseline patient characteristics and treatment components are associated with risk reduction. DESIGN AND SETTING: A cohort of individuals from a pragmatic, single-blind, cluster-randomised controlled trial of 236 females and 361 males with screen-detected type 2 diabetes and without prior cardiovascular disease (CVD), from 49 GP surgeries in eastern England, examined at baseline (2002-2006) and after 14-months' follow-up. METHOD: Multiple linear regression was used to quantify the association between baseline patient characteristics, treatment components, and change in modelled 10-year cardiovascular risk (UK Prospective Diabetes Study [UKPDS] [version 3] risk engine). RESULTS: There was a downward shift in the distribution of modelled CVD risk over 14 months mean 31% (standard deviation [SD] = 14%) to 26% [SD = 13%]). Older individuals, males, and those with a larger waist circumference at baseline exhibited smaller risk reductions. Individuals prescribed higher numbers of drugs over the follow-up period, and those who decreased their energy intake or reduced their weight, demonstrated larger reductions in modelled risk. CONCLUSION: It is possible to achieve significant reductions in modelled CVD risk over 14 months following diagnosis of diabetes by screening. Risk reduction appeared to be driven mainly by prescription of higher numbers of drugs, decreased energy intake, and weight reduction. There was room for further risk reduction, as many patients were not prescribed recommended treatments.
RCT Entities:
BACKGROUND: Uncertainties persist concerning the effects of early intensive management of type 2 diabetes and which patients benefit most from such an approach. AIM: To describe change in modelled cardiovascular risk in the 14 months following diagnosis, and to examine which baseline patient characteristics and treatment components are associated with risk reduction. DESIGN AND SETTING: A cohort of individuals from a pragmatic, single-blind, cluster-randomised controlled trial of 236 females and 361 males with screen-detected type 2 diabetes and without prior cardiovascular disease (CVD), from 49 GP surgeries in eastern England, examined at baseline (2002-2006) and after 14-months' follow-up. METHOD: Multiple linear regression was used to quantify the association between baseline patient characteristics, treatment components, and change in modelled 10-year cardiovascular risk (UK Prospective Diabetes Study [UKPDS] [version 3] risk engine). RESULTS: There was a downward shift in the distribution of modelled CVD risk over 14 months mean 31% (standard deviation [SD] = 14%) to 26% [SD = 13%]). Older individuals, males, and those with a larger waist circumference at baseline exhibited smaller risk reductions. Individuals prescribed higher numbers of drugs over the follow-up period, and those who decreased their energy intake or reduced their weight, demonstrated larger reductions in modelled risk. CONCLUSION: It is possible to achieve significant reductions in modelled CVD risk over 14 months following diagnosis of diabetes by screening. Risk reduction appeared to be driven mainly by prescription of higher numbers of drugs, decreased energy intake, and weight reduction. There was room for further risk reduction, as many patients were not prescribed recommended treatments.
Authors: Ronald J Sigal; Glen P Kenny; David H Wasserman; Carmen Castaneda-Sceppa; Russell D White Journal: Diabetes Care Date: 2006-06 Impact factor: 19.112
Authors: K A Schulman; J A Berlin; W Harless; J F Kerner; S Sistrunk; B J Gersh; R Dubé; C K Taleghani; J E Burke; S Williams; J M Eisenberg; J J Escarce Journal: N Engl J Med Date: 1999-02-25 Impact factor: 91.245
Authors: James A Black; Stephen J Sharp; Nicholas J Wareham; Annelli Sandbæk; Guy E H M Rutten; Torsten Lauritzen; Kamlesh Khunti; Melanie J Davies; Knut Borch-Johnsen; Simon J Griffin; Rebecca K Simmons Journal: Br J Gen Pract Date: 2014-04 Impact factor: 5.386