MD Conference Express EASD 2012 - (Page 22)

n c l i n i c A l T R i A l H i g H l i g H T s The study population comprised 20,184 individuals aged 40 to 69 years, from 32 general practices in Eastern England, who were considered to be at high risk of diabetes based on a validated risk score that included age, sex, body mass index (BMI), and prescription of antihypertensive medication or steroids as criteria. Twenty-seven practices were cluster randomized to a screening group (comprised of 16,047 individuals) and 5 practices to a no-screening control group (4137 individuals). Both the patients and practitioners in the no-screening group were unaware of the patients’ high-risk status. All participants were tagged for mortality at the Office for National Statistics and followed for 10 years. Screening included random capillary blood glucose and HbA1C tests, a fasting capillary test, and a confirmatory oral glucose tolerance test. The primary analysis was a comparison of allcause mortality rates and cardiovascular, cancer, and diabetes-related mortality rates between the screening and control groups. Analysis was by intention to screen accounting for clustering. Baseline practice characteristics (list size, mean diabetes prevalence, and mean index of multiple deprivation score) were similar between screening and no-screening groups. Mean age (58 years), percentage of male participants (64%), BMI (30.5 kg/m2), and prescribed antihypertensives (45%) were also similar between groups. Over a median of 9.6 years of follow-up, 15,089 (94%) of the 16,047 high-risk individuals in screening practices were invited for screening. In all, 11,737 (73.1%) attended and 466 (2.9%) were diagnosed with diabetes. A total of 4137 individuals were followed in the no-screening practices. Table 1. Mortality Rate by Study Group. Screening Group (Intervention) Number of Deaths 1532 482 697 75 Rate per 1000 Person-years 10.5 3.3 4.8 0.5 There were no differences in mortality rates by study group (Table 1). The difference in the cumulative incidence of death between the groups over time was not significant (HR, 1.06; 95% CI, 0.90 to 1.25; p=0.46). Compared with the control group, screening attenders had lower mortality (HR, 0.83; 95% CI, 0.73 to 0.94) and non-attenders had a higher mortality (HR, 1.62; 95% CI, 1.38 to 1.90; Figure 1). Figure 1. Cumulative Incidence of Death in Attenders, Nonattenders, and No-Screening Control Group. 0.12 0.10 0.08 HR,1.62; 95% CI, 1.38 to 1.90 Cumulative Probability 0.06 of Death 0.04 0.02 0.00 0 1 2 3 4 5 6 7 8 9 10 HR,0.83; 95% CI, 0.73 to 0.94 Duration of Follow-Up (Years) Control Nonattenders Attenders Reproduce with permission from R. Simmons, PhD. The investigators concluded that the benefits of screening for diabetes may have been overestimated and restricted to those found to have diabetes and treated early. The benefits of screening might be improved by the detection and management of related cardiovascular risk factors alongside assessment of diabetes risk, repeated rounds of screening, and the identification of non-attenders and strategies to maximize their utilization of screening. Further reading: Simmons et al. Lancet 2012. Endpoint No Screening Group (Control) Number of Deaths 377 124 169 16 Rate per 1000 Person-years 9.9 3.3 4.4 0.4 Hazard Ratio (95% CI) All-cause mortality CVD mortality Cancer mortality Diabetesrelated mortality 1.1 (0.9–1.3) 1.0 (0.8–1.4) 1.1 (0.9–1.3) 1.3 (0.8–2.1) 22 November 2012 www.mdconferencexpress.com http://www.mdconferencexpress.com

Table of Contents for the Digital Edition of MD Conference Express EASD 2012

MD Conference Express EASD 2012
Contents
Understanding Incretin Hormone Action and the Treatment of Diabetes
New ADA/EASD Guidelines Focus on Patient-Centered Care
ORIGIN Trial: Insulin Glargine and n-3 Fatty Acids Fail to Reduce CV Events in Diabetic Patients
Exenatide Once Weekly Sustained Improvement in Glycemic Control with Weight Loss Through 4 Years
DiaPep277® Shows Promise as a Therapeutic Strategy for T1DM
Linagliptin Proves Safe and Effective as Add-on Therapy to Basal Insulin
12-Week Treatment with LY2409021 Significantly Lowers HbA1C and Is Well Tolerated in Patients with T2DM
Insulin Degludec Is Superior to Sitagliptin in Improving Glycemic Control in Uncontrolled Patients with Type 2 Diabetes on Oral Agents
Dapagliflozin Does Not Impact Renal Function in Patients with T2DM
Population-Based Screening for T2DM:The ADDITION-Cambridge Trial
The Challenges of Pharmaceutical Management of Painful Diabetic Peripheral Neuropathy
Enterovirus Infection
Novel Oral Agents
GLP-1
Genetics
Renal Denervation
Hypertension and Renal Function Are Risk Factors for CAD in T1DM

MD Conference Express EASD 2012

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