Sustained Improvements in CVD Risk With Intensive T2D Intervention

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The protocol for the intensive treatment group included an education program, 3 to 6 monthly specialist clinics, support in capillary glucose monitoring, and access to nurse-led advisory services.
The protocol for the intensive treatment group included an education program, 3 to 6 monthly specialist clinics, support in capillary glucose monitoring, and access to nurse-led advisory services.

Intensive multifactorial interventions that are implemented in a multi-ethnic population with type 2 diabetes led to sustained improvements in a model of cardiovascular disease (CVD) outcomes, reports a study published in Diabetes Metabolism Research and Reviews.

Interventions for mitigating CVD risk are often multifactorial and combine behavior change, lifestyle modification, and pharmaceutical therapy. Screening can be highly effective in identifying individuals with type 2 diabetes who are at high risk and provides opportunities for earlier intervention. In this study, researchers used data from the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen-Detected Diabetes in Primary Care (ADDITION)‐Leicester study to estimate differences in modeled risk for all-cause death, CVD (ischemic heart disease, stroke, and congestive heart failure), and blindness, using United Kingdom Prospective Diabetes Study outcomes risk prediction models.

The cohort included 345 individuals with screen‐detected type 2 diabetes who were randomly assigned to receive either 5 years of intensive multifactorial risk factor intervention or standard treatment per national guidelines. The protocol for the intensive treatment group included a structured education program, 3 to 6 monthly specialist peripatetic clinics, support in capillary glucose monitoring, and access to nurse-led advisory services in addition to lower targets for blood glucose, blood pressure, and total cholesterol than the standard care group.

Compared with standard care, the mean differences for intensive intervention at 5 years were:

  • ‐11.7 mm Hg in systolic blood pressure (95% CI, ‐15.0 to ‐8.4)
  • ‐6.6 mm Hg in diastolic blood pressure (95% CI, ‐8.8 to ‐4.4)
  • ‐0.27% in glycated hemoglobin (95% CI, ‐0.48 to ‐0.06)
  • ‐0.46 mmol/L in total cholesterol (95% CI, ‐0.66 to ‐0.26)
  • ‐0.34 mmol/L in low-density lipoprotein cholesterol (95% CI, ‐0.51 to ‐0.18)
  • ‐0.19 mmol/L in triglycerides (95% CI, ‐0.28 to ‐0.10)

The researchers also found that the modeled risks were consistently lower for those in the intensive care group. The absolute risk reduction at 10 and 20 years was 3.5% and 6.2% for ischemic heart disease and 6.3% and 8.8% for stroke, respectively, compared with standard care. There were no significant differences between groups for body mass index, blindness, or all‐cause death.

The researchers noted it is important that “robust data relating to complications risk is available to aid decision makers across a range of populations over time. This is particularly pertinent in people with type 2 diabetes identified through screening and within perceived [high-risk] ethnic minority populations, where a significant number of cardiovascular risk factor treatments are indicated and many years of diabetes exposure potentially accrued.”

Reference

Webb D, Dales J, Zaccardi F, et al. Intensive versus standard multifactorial cardiovascular risk factor control in screen-detected type 2 diabetes: 5 year and longer-term modelled outcomes of the ADDITION-Leicester study. Diabetes Metab Res Rev. 2018:e3111.

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