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Diabetes Management
Table 1: Baseline Characteristics and Changes in Biomedical Variables After One Year in Both Treatment Groups
Routine Care (n=243) Intensive Treatment (n=255) p-value*
Baseline 1 year Baseline 1 year
Demographic Variables
Gender (% male) 56.0 51.8
Age (years) 59.9±5.1 60.1±5.4
Ethnicity (% Caucasian) 98.7 98.0
Behavioural Variables
Current smoking (%) 21.4 26.3
Ever smoked (%) 68.0 66.1
Drinking alcohol (%) 78.1 78.4
Weekly ≥5 pieces of fruit (%) 61.7 57.6
Exercise (days per week ≥30 min) 3.8±2.5 4.0±2.3
Clinical Variables
BMI (kg/m
2
) 30.4±4.6 30.6±4.8 31.2±5.1 29.8±4.8 <0.001
Systolic blood pressure (mmHg) 163±23 144±17 166±23 133±17 <0.001
Diastolic blood pressure (mmHg) 89±10 82±8 90±11 78±9 <0.001
Biochemical Variables
Fasting blood glucose (mmol/l) 8.1±2.8 7.2±1.7 7.8±2.3 6.5±1.1 0.02
HbA
1c
(%) 7.4±1.7 6.5±0.9 7.3±1.6 6.2±0.6 0.03
Cholesterol (mmol/l) 5.6±1.1 5.1±1.0 5.6±1.1 4.4±0.9 <0.001
HDL cholesterol (mmol/l) 1.1±0.3 1.2±0.9 1.1±0.4 1.1±0.3 0.26
LDL cholesterol (mmol/l) 3.7±1.0 3.2±1.0 3.7±1.0 2.7±0.8 <0.001
Triglycerides (mmol/l) 2.0±1.6 1.7±1.7 1.9±1.0 1.5±0.8 0.71
Practices
Single-handed (%) 50.0 43.2
Urban location (%) 52.4 29.7
Specific diabetes clinic (%) 63.4 62.2
≥10% patients from ethnic 7.1 8.1
minority groups (%)
Data are means ± standard deviation (SD) unless otherwise indicated. *Comparison of changes in variables between treatment groups adjusted for age, gender, baseline value and clustering
at practice level. BMI = body mass index; HbA = glycated haemoglobin; HDL = high-density lipoprotein; LDL = low-density lipoprotein. Source: Paul GH Janssen, Kees J Gorter, Ronald P Stolk1c
and Guy EHM Rutten, Randomised controlled trial of intensive multifactorial treatment for cardiovascular risk in patients with screen-detected type 2 diabetes: 1-year data from the ADDITION
Netherlands study, Br J Gen Pract, 2009;59:43–48.
Table 2: SF-36 Scores at Baseline and After One Year in Both Treatment Groups
Routine Care (n=243) Intensive Treatment (n=255) Difference Between Groups*
Baseline One year Baseline One year p-value
General health 59.7±12.0 64.4±18.1
†
59.1±11.5 63.3±18.4
†
0.632
Vitality 52.2±13.2 67.1±18.4
†
49.3±14.4 64.8±20.4
†
0.814
Mental health 69.9±12.6 79.0±15.6
†
68.4±13.3 75.9±17.9
†
0.559
Physical functioning 78.3±22.0 78.1±23.2 77.4±21.9 80.1±21.2
†
0.218
Role physical 84.9±30.0 81.1±33.5 82.8±31.4 80.3±35.0 0.930
Bodily pain 84.7±20.7 82.2±22.4 80.8±22.1 79.2±22.7 0.970
Social functioning 89.0±17.2 85.7±19.2
†
87.9±20.0 83.0±22.0
†
0.368
Role emotional 85.4±32.4 89.9±26.0 88.2±28.6 86.2±30.9 0.254
Data are means ± standard deviation (SD). SF-36 = Short Form 36. *Differences between treatment groups at end of study, adjusted for age, gender and baseline value.
†
Difference between baseline and at end of study within group is significant. Source: Paul GH Janssen, Kees J Gorter, Ronald P Stolk and Guy EHM Rutten, Randomised controlled trial of
intensive multifactorial treatment for cardiovascular risk in patients with screen-detected type 2 diabetes: 1-year data from the ADDITION Netherlands study, Br J Gen Pract, 2009;59:43–48.
regulation urges a proactive approach by healthcare providers in risk factors in people with screening-detected diabetes.
19
In the Steno-2
order to reduce the cardiovascular risk of their patients.
18
Study, in which diabetic patients with microalbuminuria were included,
Opportunistic screening in general practice for people with impaired the cardiovascular event rate was cut by half in the intensively treated
glucose regulation could begin by filling in the risk questionnaire group (mean follow-up 7.8 years).
20,21
during practice visits.
At the end of follow-up, SF-36 scores were similar for the two groups,
Intensified Multifactorial Treatment of suggesting no major detrimental impact on quality of life from
Screening-detected Type 2 Diabetic Patients the intensive intervention. Intensified multifactorial treatment of
We found spectacular improvements in cardiovascular risk factor levels screening-detected patients with diabetes in general practice is likely
in the intensively treated group compared with the routine care group to be feasible at the patient level. In a subset of patients in the
even after only one year of treatment. The final results of the ADDITION ADDITION cohort (n=196), psychological outcomes were examined.
22
study, due in 2010, must be awaited before we can evaluate the The intensively treated patients tended to report more distress and
effectiveness of early aggressive five-year treatment of all cardiovascular less self-efficacy in the first year after diagnosis than those who
36 EUROPEAN ENDOCRINOLOGY
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