Evidence mapPaperPMID 24533664Full record

Trial reportDiabetic medicine : a journal of the British Diabetic Association2014

Does early intensive multifactorial therapy reduce modelled cardiovascular risk in individuals with screen-detected diabetes? Results from the ADDITION-Europe cluster randomized trial.

J A Black, S J Sharp, N J Wareham, A Sandbaek, G E H M Rutten, T Lauritzen, K Khunti, M J Davies, K Borch-Johnsen, S J Griffin and 1 more

Abstract readMulticenter StudyPragmatic Clinical TrialRandomized Controlled Trial
In one paragraph

Trial report in Diabetic medicine : a journal of the British Diabetic Association, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 2 pooled it
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Screening for type 2 diabetes mellitus.The Cochrane database of systematic reviews · 2020
    Pooled it
  2. Risk scoring for the primary prevention of cardiovascular disease.The Cochrane database of systematic reviews · 2017
    Pooled it
  3. Trial
  4. Article
  5. Glucose-lowering therapy in patients undergoing percutaneous coronary intervention.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2021
    Review
  6. The combination of coronary artery disease and type 2 diabetes: a therapeutic challenge.European heart journal supplements : journal of the European Society of Cardiology · 2019
    Article
  7. Article
  8. Article
  9. Article
  10. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

J A BlackMRC Epidemiology Unit, Cambridge University Biomedical Campus, Cambridge, UK.
S J Sharp
N J Wareham
A Sandbaek
G E H M Rutten
T Lauritzen
K Khunti
M J Davies
K Borch-Johnsen
S J Griffin
R K Simmons

Funding

Medical Research Council G0001164Medical Research Council MC_U106179471Medical Research Council MC_U106179474Medical Research Council MC_UU_12015/1Medical Research Council MC_UU_12015/4Wellcome Trust G061895
6 · The paper itself

Abstract

aimsLittle is known about the long-term effects of intensive multifactorial treatment early in the diabetes disease trajectory. In the absence of long-term data on hard outcomes, we described change in 10-year modelled cardiovascular risk in the 5 years following diagnosis, and quantified the impact of intensive treatment on 10-year modelled cardiovascular risk at 5 years.

methodsIn a pragmatic, cluster-randomized, parallel-group trial in Denmark, the Netherlands and the UK, 3057 people with screen-detected Type 2 diabetes were randomized by general practice to receive (1) routine care of diabetes according to national guidelines (1379 patients) or (2) intensive multifactorial target-driven management (1678 patients). Ten-year modelled cardiovascular disease risk was calculated at baseline and 5 years using the UK Prospective Diabetes Study Risk Engine (version 3β).

resultsAmong 2101 individuals with complete data at follow up (73.4%), 10-year modelled cardiovascular disease risk was 27.3% (sd 13.9) at baseline and 21.3% (sd 13.8) at 5-year follow-up (intensive treatment group difference -6.9, sd 9.0; routine care group difference -5.0, sd 12.2). Modelled 10-year cardiovascular disease risk was lower in the intensive treatment group compared with the routine care group at 5 years, after adjustment for baseline cardiovascular disease risk and clustering (-2.0; 95% CI -3.1 to -0.9).

conclusionsDespite increasing age and diabetes duration, there was a decline in modelled cardiovascular disease risk in the 5 years following diagnosis. Compared with routine care, 10-year modelled cardiovascular disease risk was lower in the intensive treatment group at 5 years. Our results suggest that patients benefit from intensive treatment early in the diabetes disease trajectory, where the rate of cardiovascular disease risk progression may be slowed.

Indexed as

AdultAgedCombined Modality TherapyDiabetes Mellitus, Type 2Diabetic AngiopathiesEarly DiagnosisEpidemiologic MethodsFemaleHumansMaleMiddle AgedModels, CardiovascularTreatment Outcome

Identifiers

PMID24533664
PMCPMC4150529

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.