TY - JOUR
T1 - Long-Term effect of population screening for diabetes on cardiovascular morbidity, self-rated health, and health behavior
AU - Echouffo-Tcheugui, Justin B.
AU - Simmons, Rebecca K.
AU - Prevost, A. Toby
AU - Williams, Kate M.
AU - Kinmonth, Ann Louise
AU - Wareham, Nicholas J.
AU - Griffin, Simon J.
N1 - Funding Information:
Funding support: ADDITION-Cambridge was supported by the Well-come Trust (grant reference no: G061895 ), the Medical Research Council (grant reference no: G0001164), National Health Service R&D support funding, the National Institute for Health Research (NIHR) and the MRC Epidemiology Unit. We received an unrestricted grant from University of Aarhus, Denmark, to support the ADDITION-Cambridge trial. Bio-Rad provided equipment to undertake capillary glucose screening by HbA 1c in general practice. A-L.K. was an NIHR Senior Investigator. The Primary Care Unit was supported by NIHR Research funds. S.J.G. received support from the Department of Health NIHR Program Grant funding scheme [ RP-PG-0606-1259 ]. A.T.P. was supported by the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.
Publisher Copyright:
© 2015, Annals of Family Medicine, Inc. All right reserved.
PY - 2015
Y1 - 2015
N2 - PURPOSE There is limited trial evidence concerning the long-term effects of screening for type 2 diabetes on population morbidity. We examined the effect of a population-based diabetes screening program on cardiovascular morbidity, self-rated health, and health-related behaviors. METHODS We conducted a pragmatic, parallel-group, cluster-randomized controlled trial of diabetes screening (the ADDITION-Cambridge study) including 18,875 individuals aged 40 to 69 years at high risk of diabetes in 32 general practices in eastern England (27 practices randomly allocated to screening, 5 to no-screening for control). Of those eligible for screening, 466 (2.9%) were diagnosed with diabetes. Seven years after randomization, a random sample of patients was sent a postal questionnaire: 15% from the screening group (including diabetes screening visit attenders and non-attenders) and 40% from the noscreening control group. Self-reported cardiovascular morbidity, self-rated health (using the SF-8 Health Survey and EQ-5D instrument), and health behaviors were compared between trial groups using an intention-to-screen analysis. RESULTS Of the 3,286 questionnaires mailed out, 1,995 (61%) were returned, with 1,945 included in the analysis (screening: 1,373; control: 572). At 7 years, there were no significant differences between the screening and control groups in the proportion of participants reporting heart attack or stroke (OR = 0.90, 95% CI, 0.71-1.15); SF-8 physical health summary score as an indicator of selfrated health status (β –0.33, 95% CI, –1.80 to 1.14); EQ-5D visual analogue score (β: 0.80, 95% CI, –1.28 to 2.87); total physical activity (β 0.50, 95% CI, –4.08 to 5.07); current smoking (OR 0.97, 95% CI, 0.72 to 1.32); and alcohol consumption (β 0.14, 95% CI, –1.07 to 1.35). CONCLUSIONS Invitation to screening for type 2 diabetes appears to have limited impact on population levels of cardiovascular morbidity, self-rated health status, and health behavior after 7 years.
AB - PURPOSE There is limited trial evidence concerning the long-term effects of screening for type 2 diabetes on population morbidity. We examined the effect of a population-based diabetes screening program on cardiovascular morbidity, self-rated health, and health-related behaviors. METHODS We conducted a pragmatic, parallel-group, cluster-randomized controlled trial of diabetes screening (the ADDITION-Cambridge study) including 18,875 individuals aged 40 to 69 years at high risk of diabetes in 32 general practices in eastern England (27 practices randomly allocated to screening, 5 to no-screening for control). Of those eligible for screening, 466 (2.9%) were diagnosed with diabetes. Seven years after randomization, a random sample of patients was sent a postal questionnaire: 15% from the screening group (including diabetes screening visit attenders and non-attenders) and 40% from the noscreening control group. Self-reported cardiovascular morbidity, self-rated health (using the SF-8 Health Survey and EQ-5D instrument), and health behaviors were compared between trial groups using an intention-to-screen analysis. RESULTS Of the 3,286 questionnaires mailed out, 1,995 (61%) were returned, with 1,945 included in the analysis (screening: 1,373; control: 572). At 7 years, there were no significant differences between the screening and control groups in the proportion of participants reporting heart attack or stroke (OR = 0.90, 95% CI, 0.71-1.15); SF-8 physical health summary score as an indicator of selfrated health status (β –0.33, 95% CI, –1.80 to 1.14); EQ-5D visual analogue score (β: 0.80, 95% CI, –1.28 to 2.87); total physical activity (β 0.50, 95% CI, –4.08 to 5.07); current smoking (OR 0.97, 95% CI, 0.72 to 1.32); and alcohol consumption (β 0.14, 95% CI, –1.07 to 1.35). CONCLUSIONS Invitation to screening for type 2 diabetes appears to have limited impact on population levels of cardiovascular morbidity, self-rated health status, and health behavior after 7 years.
KW - ADDITION-Cambridge
KW - Cardiovascular morbidity
KW - Diabetes
KW - Health behavior
KW - Screening
KW - Self-rated health
UR - http://www.scopus.com/inward/record.url?scp=84924336089&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84924336089&partnerID=8YFLogxK
U2 - 10.1370/afm.1737
DO - 10.1370/afm.1737
M3 - Article
C2 - 25755036
AN - SCOPUS:84924336089
SN - 1544-1709
VL - 13
SP - 149
EP - 157
JO - Annals of Family Medicine
JF - Annals of Family Medicine
IS - 2
ER -