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. The aim was 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.