Screening to identify Type 2 diabetes followed by early treatment could result in substantial health benefits, according to new research published May 18 in Diabetes Care that combined large scale clinical observations and innovative computer modelling.
The study, led by researchers at the University of Michigan and the MRC Epidemiology Unit, University of Cambridge, used data from the ADDITION-Europe study of diabetes screening and treatment, which it combined with a computer simulation model of diabetes progression.
This approach revealed that screening followed by treatment led to a reduced risk of cardiovascular disease or death within a five-year follow-up period when compared to patients having no screening.
“Diabetes can be debilitating for patients and costly for healthcare,” says Dr. William Herman, lead author of the paper and a professor at the University of Michigan Medical School and School of Public Health. “This research shows that the early identification of diabetes has major health benefits, and supports the introduction of measures such as screening to reduce the time between development of Type 2 diabetes and its treatment.”
Professor Nick Wareham, senior author on the paper and director of the MRC Epidemiology Unit, University of Cambridge, added: “This work shows the value of public health modelling to assess impacts and interventions for diseases such as Type 2 diabetes that pose an increasing public health challenge.
At 10 years after baseline, the simulations predicted that with a delay of three years in diagnosis and treatment, 22.4 percent of those with Type 2 diabetes would experience a cardiovascular disease event, such as stroke or heart bypass surgery. This rose to 25.9 percent with a diagnosis delay of six years.
However, if screening and routine care had been implemented, the simulation predicted only 18.4 percent would experience a cardiovascular disease event at 10 years after baseline. The simulated incidence of all-cause mortality was 16.4 percent with a delay of three years and 18.2 percent with a delay of six years, compared to 14.6 percent for screening and treatment.
This means that over 10 years, the model predicts that for people with undiagnosed Type 2 diabetes, screening would be associated with a 29 percent reduction in relative risk of a cardiovascular disease event, compared with a delay of six years in diagnosis and treatment.
This amounts to a 7.5 percent reduction in the absolute risk of adverse cardiovascular outcome in this population. The comparable change in all-cause mortality was 20 percent relative risk and 3.6 percent absolute risk reduction.
Dr. Herman is a professor in the Metabolism, Endocrine and Diabetes division of the U-M Department of Internal Medicine, a professor in the U-M School of Public Health, and a member of the U-M Institute for Healthcare Policy and Innovation.
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