Effect of Population Screening for Type 2 Diabetes and Cardiovascular Risk Factors on Mortality Rate and Cardiovascular Events: a Controlled Trial Among 1,912,392 Danish Adults

Overview

Journal Diabetologia

Specialty Endocrinology

Date 2017 Aug 24

PMID 28831535

Citations 27

Authors

Rebecca K Simmons

Simon J Griffin

Daniel R Witte

Knut Borch-Johnsen

Torsten Lauritzen

Annelli Sandbaek

Affiliations

Soon will be listed here.

Abstract

Aims/hypothesis: Health check programmes for chronic disease have been introduced in a number of countries. However, there are few trials assessing the benefits and harms of these screening programmes at the population level. In a post hoc analysis, we evaluated the effect of population-based screening for type 2 diabetes and cardiovascular risk factors on mortality rates and cardiovascular events.

Methods: This register-based, non-randomised, controlled trial included men and women aged 40-69 years without known diabetes who were registered with a general practice in Denmark (n = 1,912,392). Between 2001 and 2006, 153,107 individuals registered with 181 practices participating in the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION)-Denmark study were sent a diabetes risk score questionnaire. Individuals at moderate-to-high risk were invited to visit their GP for assessment of diabetes status and cardiovascular risk (screening group). The 1,759,285 individuals registered with all other general practices in Denmark constituted the retrospectively constructed no-screening (control) group. Outcomes were mortality rate and cardiovascular events (cardiovascular disease death, non-fatal ischaemic heart disease or stroke). The analysis was performed according to the intention-to-screen principle.

Results: Among the screening group, 27,177 (18%) individuals attended for assessment of diabetes status and cardiovascular risk. Of these, 1,533 were diagnosed with diabetes. During a median follow-up of 9.5 years, there were 11,826 deaths in the screening group and 141,719 in the no-screening group (HR 0.99 [95% CI 0.96, 1.02], p = 0.66). There were 17,941 cardiovascular events in the screening group and 208,476 in the no-screening group (HR 0.99 [0.96, 1.02], p = 0.49).

Conclusions/interpretation: A population-based stepwise screening programme for type 2 diabetes and cardiovascular risk factors among all middle-aged adults in Denmark was not associated with a reduction in rate of mortality or cardiovascular events between 2001 and 2012.

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References

Siu A . Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2015; 163(11):861-8. DOI: 10.7326/M15-2345. View

Griffin S, Borch-Johnsen K, Davies M, Khunti K, Rutten G, Sandbaek A . Effect of early intensive multifactorial therapy on 5-year cardiovascular outcomes in individuals with type 2 diabetes detected by screening (ADDITION-Europe): a cluster-randomised trial. Lancet. 2011; 378(9786):156-67. PMC: 3136726. DOI: 10.1016/S0140-6736(11)60698-3. View

Jorgensen T, Jacobsen R, Toft U, Aadahl M, Glumer C, Pisinger C . Effect of screening and lifestyle counselling on incidence of ischaemic heart disease in general population: Inter99 randomised trial. BMJ. 2014; 348:g3617. PMC: 4049194. DOI: 10.1136/bmj.g3617. View

Simmons R, Echouffo-Tcheugui J, Sharp S, Sargeant L, Williams K, Prevost A . Screening for type 2 diabetes and population mortality over 10 years (ADDITION-Cambridge): a cluster-randomised controlled trial. Lancet. 2012; 380(9855):1741-8. PMC: 3607818. DOI: 10.1016/S0140-6736(12)61422-6. View

Alberti K, Zimmet P . Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998; 15(7):539-53. DOI: 10.1002/(SICI)1096-9136(199807)15:7<539::AID-DIA668>3.0.CO;2-S. View

Graversen L, Christensen B, Borch-Johnsen K, Lauritzen T, Sandbaek A . General practitioners' adherence to guidelines on management of dyslipidaemia: ADDITION-Denmark. Scand J Prim Health Care. 2009; 28(1):47-54. PMC: 3440615. DOI: 10.3109/02813430903335216. View

Christensen J, Sandbaek A, Lauritzen T, Borch-Johnsen K . Population-based stepwise screening for unrecognised Type 2 diabetes is ineffective in general practice despite reliable algorithms. Diabetologia. 2004; 47(9):1566-73. DOI: 10.1007/s00125-004-1496-2. View

Robson J, Dostal I, Sheikh A, Eldridge S, Madurasinghe V, Griffiths C . The NHS Health Check in England: an evaluation of the first 4 years. BMJ Open. 2016; 6(1):e008840. PMC: 4735215. DOI: 10.1136/bmjopen-2015-008840. View

Simmons R, Carlsen A, Griffin S, Charles M, Christiansen J, Borch-Johnsen K . Variation in prescribing of lipid-lowering medication in primary care is associated with incidence of cardiovascular disease and all-cause mortality in people with screen-detected diabetes: findings from the ADDITION-Denmark trial. Diabet Med. 2014; 31(12):1577-85. PMC: 4283975. DOI: 10.1111/dme.12574. View

10.

Krogsboll L, Jorgensen K, Larsen C, Gotzsche P . General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database Syst Rev. 2012; 10:CD009009. DOI: 10.1002/14651858.CD009009.pub2. View

11.

Kahn R, Alperin P, Eddy D, Borch-Johnsen K, Buse J, Feigelman J . Age at initiation and frequency of screening to detect type 2 diabetes: a cost-effectiveness analysis. Lancet. 2010; 375(9723):1365-74. DOI: 10.1016/S0140-6736(09)62162-0. View

12.

Eborall H, Davies R, Kinmonth A, Griffin S, Lawton J . Patients' experiences of screening for type 2 diabetes: prospective qualitative study embedded in the ADDITION (Cambridge) randomised controlled trial. BMJ. 2007; 335(7618):490. PMC: 1971165. DOI: 10.1136/bmj.39308.392176.BE. View

13.

Eborall H, Griffin S, Prevost A, Kinmonth A, French D, Sutton S . Psychological impact of screening for type 2 diabetes: controlled trial and comparative study embedded in the ADDITION (Cambridge) randomised controlled trial. BMJ. 2007; 335(7618):486. PMC: 1971192. DOI: 10.1136/bmj.39303.723449.55. View

14.

Sargeant L, Simmons R, Barling R, Butler R, Williams K, Prevost A . Who attends a UK diabetes screening programme? Findings from the ADDITION-Cambridge study. Diabet Med. 2010; 27(9):995-1003. PMC: 3428846. DOI: 10.1111/j.1464-5491.2010.03056.x. View

15.

Conroy R, Pyorala K, Fitzgerald A, Sans S, Menotti A, De Backer G . Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003; 24(11):987-1003. DOI: 10.1016/s0195-668x(03)00114-3. View

16.

Prasad V, Lenzer J, Newman D . Why cancer screening has never been shown to "save lives"--and what we can do about it. BMJ. 2016; 352:h6080. DOI: 10.1136/bmj.h6080. View

17.

Simmons R, Griffin S, Lauritzen T, Sandbaek A . Effect of screening for type 2 diabetes on risk of cardiovascular disease and mortality: a controlled trial among 139,075 individuals diagnosed with diabetes in Denmark between 2001 and 2009. Diabetologia. 2017; 60(11):2192-2199. PMC: 6108415. DOI: 10.1007/s00125-017-4299-y. View

18.

Glumer C, Carstensen B, Sandbaek A, Lauritzen T, Jorgensen T, Borch-Johnsen K . A Danish diabetes risk score for targeted screening: the Inter99 study. Diabetes Care. 2004; 27(3):727-33. DOI: 10.2337/diacare.27.3.727. View

19.

Chang H, Kuo H, Tung T, Chou P, Chen T . Evaluation of a population-based screening for type 2 diabetes: a community-based screening project in Puli, Taiwan. Prev Med. 2000; 31(4):396-402. DOI: 10.1006/pmed.2000.0728. View

20.

Rasmussen S, Johansen N, Witte D, Borch-Johnsen K, Sandbaek A, Lauritzen T . Incidence of register-based diabetes 10 years after a stepwise diabetes screening programme: the ADDITION-Denmark study. Diabetologia. 2016; 59(5):989-97. DOI: 10.1007/s00125-016-3887-6. View