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A single screening for type 2 diabetes in high-risk adults did not reduce mortality over 10 years.
MedLine Citation:
PMID:  23318338     Owner:  NLM     Status:  In-Data-Review    
QUESTION Does a stepwise screening program for type 2 diabetes reduce mortality compared with no screening in high-risk persons? METHODS DESIGN Pragmatic, cluster-randomized, controlled trial (ADDITION-Cambridge trial). Current Controlled Trials ISRCTN86769081. ALLOCATION {Concealed}*.† BLINDING Blinded† (outcome assessors and data analysts). FOLLOW-UP PERIOD Median 9.6 years. SETTING 33 general practices in eastern England, UK. PARTICIPANTS 20 184 persons 40 to 69 years of age (mean age 58 y, 64% men) who were at high risk for undiagnosed diabetes (score ≥ 0.17 on a validated risk score calculated using data from electronic medical records: age, sex, body mass index, and prescriptions for steroid and antihypertensive medications). Exclusion criteria included life expectancy < 1 year, psychiatric illness affecting study participation, or pregnancy or lactation. INTERVENTION Stepwise screening followed by intensive treatment (n = 15 practices) or routine care (n = 13 practices) for persons with screen-detected diabetes (n = 16 047 participants for both screening groups combined), or no screening (n = 5 practices, n = 4137 participants). Stepwise screening included random capillary blood glucose and glycated hemoglobin (HbA1c) tests and, based on initial blood glucose levels, no further testing (no diabetes), fasting capillary blood glucose test and confirmatory oral glucose tolerance test (OGTT) if necessary, or an OGTT only. OUTCOMES Primary outcome was all-cause mortality. Secondary outcomes included cardiovascular (CV), cancer, and diabetes-related mortality. PARTICIPANT FOLLOW-UP 99% of participants and 97% of practices (intention-to-screen analysis). MAIN RESULTS 3% of persons in the screening groups were diagnosed with diabetes. Screening for type 2 diabetes did not reduce all-cause, CV, cancer, or diabetes-related mortality compared with no screening (Table). CONCLUSION A single screening for type 2 diabetes in high-risk persons did not reduce mortality over 10 years compared with no screening.Screening vs no screening for type 2 diabetes in high-risk persons‡OutcomesEvent rate/1000 patient-yAt a median 9.6 y of follow-upScreeningNo screeningRRI (95% CI)All-cause mortality10.59.896% (-10 to 24)Cardiovascular mortality3.303.252% (-25 to 37)Cancer mortality4.784.438% (-10 to 29)Diabetes-related mortality0.510.4226% (-25 to 110)‡Abbreviations defined in Glossary. RRI and CI calculated from event rates and hazard ratios (adjusted for clustering) in article.
Jeffrey Mahon
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of internal medicine     Volume:  158     ISSN:  1539-3704     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  JC4     Citation Subset:  AIM; IM    
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