TY - JOUR
T1 - Change in cardiovascular risk factors following early diagnosis of type 2 diabetes
T2 - A cohort analysis of a cluster-randomised trial
AU - Black, James A.
AU - Sharp, Stephen J.
AU - Wareham, Nicholas J.
AU - Sandbkæ, Annelli
AU - Rutten, Guy Ehm
AU - Lauritzen, Torsten
AU - Khunti, Kamlesh
AU - Davies, Melanie J.
AU - Borch-Johnsen, Knut
AU - Griffin, Simon J.
AU - Simmons, Rebecca K.
PY - 2014/4/1
Y1 - 2014/4/1
N2 - Background: There is little evidence to inform the targeted treatment of individuals found early in the diabetes disease trajectory. Aim: To describe cardiovascular disease (CVD) risk profiles and treatment of individual CVD risk factors by modelled CVD risk at diagnosis; changes in treatment, modelled CVD risk, and CVD risk factors in the 5 years following diagnosis; and how these are patterned by socioeconomic status. Design and setting: Cohort analysis of a cluster-randomised trial (ADDITION-Europe) in general practices in Denmark, England, and the Netherlands. Method: A total of 2418 individuals with screen-detected diabetes were divided into quartiles of modelled 10-year CVD risk at diagnosis. Changes in treatment, modelled CVD risk, and CVD risk factors were assessed at 5 years. Results: The largest reductions in risk factors and modelled CVD risk were seen in participants who were in the highest quartile of modelled risk at baseline, suggesting that treatment was offered appropriately. Participants in the lowest quartile of risk at baseline had very similar levels of modelled CVD risk at 5 years and showed the least variation in change in modelled risk. No association was found between socioeconomic status and changes in CVD risk factors, suggesting that treatment was equitable. Conclusion: Diabetes management requires setting of individualised attainable targets. This analysis provides a reference point for patients, clinicians, and policymakers when considering goals for changes in risk factors early in the course of the disease that account for the diverse cardiometabolic profile present in individuals who are newly diagnosed with type 2 diabetes.
AB - Background: There is little evidence to inform the targeted treatment of individuals found early in the diabetes disease trajectory. Aim: To describe cardiovascular disease (CVD) risk profiles and treatment of individual CVD risk factors by modelled CVD risk at diagnosis; changes in treatment, modelled CVD risk, and CVD risk factors in the 5 years following diagnosis; and how these are patterned by socioeconomic status. Design and setting: Cohort analysis of a cluster-randomised trial (ADDITION-Europe) in general practices in Denmark, England, and the Netherlands. Method: A total of 2418 individuals with screen-detected diabetes were divided into quartiles of modelled 10-year CVD risk at diagnosis. Changes in treatment, modelled CVD risk, and CVD risk factors were assessed at 5 years. Results: The largest reductions in risk factors and modelled CVD risk were seen in participants who were in the highest quartile of modelled risk at baseline, suggesting that treatment was offered appropriately. Participants in the lowest quartile of risk at baseline had very similar levels of modelled CVD risk at 5 years and showed the least variation in change in modelled risk. No association was found between socioeconomic status and changes in CVD risk factors, suggesting that treatment was equitable. Conclusion: Diabetes management requires setting of individualised attainable targets. This analysis provides a reference point for patients, clinicians, and policymakers when considering goals for changes in risk factors early in the course of the disease that account for the diverse cardiometabolic profile present in individuals who are newly diagnosed with type 2 diabetes.
KW - Cardiovascular diseases
KW - Diabetes mellitus, type 2
KW - Prevention and control
KW - Primary health care
KW - Risk assessment
KW - Risk factors
KW - Treatment heterogeneity
UR - http://www.scopus.com/inward/record.url?scp=84898761227&partnerID=8YFLogxK
U2 - 10.3399/bjgp14X677833
DO - 10.3399/bjgp14X677833
M3 - Article
C2 - 24686885
AN - SCOPUS:84898761227
VL - 64
SP - e208-e216
JO - British Journal of General Practice
JF - British Journal of General Practice
SN - 0960-1643
IS - 621
ER -