Effect of Early Intensive Multifactorial Therapy on 5 year CVD outcomes in DM2 Detected by Screening (ADDITION-Europe Study); Torsten Lauritzen; ADA 2011

The ADDITION study is a study of people

with screen detected DM2 in a multicenter European design. Aim to evaluate a intensive multifactorial

CVD intervention in primary care early into the course of DM2. A stepwise screening programme was targeted

at people with high diabetes risk in general practice. Target population was nearly 400,00 people

aged 40-69 years. About 70,000 high risk

people screened and identified just over 3000 people with DM2. Patients were randomized to routine care or

intensive treatment. In the intensive

group there was a target driven protocol if HbA1c > 6.5% increase glycaemic

treatment. Target BP <135/85 and

target Total Cholesterol 3.5 mmol/l.

Around 1,350 patient in each arm, mean age about 57 years and > 90%

Caucasian. Almost 100% 5 year follow up

was achieved.

At baseline about 45% were on BP lowering

drugs. At 5 years almost twice as many were on BP lowering drugs, but more so

in intensive group. About 12% on stating

at baseline but far more at 5 years with around 70% with a similar pattern to

BP drugs. This resulted in significantly

greater reductions in BP and Cholesterol in the intensive group at 5 years.

Primary endpoints were CVD events. There was a NS 17% risk reduction in favour

of intensive treatment at 5 years.

Intensive glucose management was NOT associated with increased risk of

mortality. Mortality in both groups was

low and only slightly higher than the general population. Comparison with the Michigan CVD mortality

model suggests that compared to a model without treatment there was a

significant reduction in mortality in both routine and intensive groups.

In conclusion it is possible to screen for

DM2 in primary care and this improves early detection and CVD risk

intervention. In the present study both

routine and intensive groups sustained significantly reduced mortality when

compared with a mortality model without treatment intervention. There was a non-significant 17% reduction in

CVD mortality if intensive risk factor intervention is initiated early in DM2.