RT Journal Article
SR Electronic
T1 Change in cardiovascular risk factors following early diagnosis of type 2 diabetes: a cohort analysis of a cluster-randomised trial
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e208
OP e216
DO 10.3399/bjgp14X677833
VO 64
IS 621
A1 James A Black
A1 Stephen J Sharp
A1 Nicholas J Wareham
A1 Annelli Sandbæk
A1 Guy EHM Rutten
A1 Torsten Lauritzen
A1 Kamlesh Khunti
A1 Melanie J Davies
A1 Knut Borch-Johnsen
A1 Simon J Griffin
A1 Rebecca K Simmons
YR 2014
UL http://bjgp.org/content/64/621/e208.abstract
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.