Routine Diabetes Screening, Early Intervention Needed
Studies Support Early Focus on Dietary Changes, Cardiovascular Risks
With type 2 diabetes now dramatically increasing in European countries where systematic screening is not consistently or routinely employed, researchers are exploring how early detection and intervention can help increase control of the disease and reduce life-threatening complications such as cardiovascular disease. Two such studies presented data today at the American Diabetes Association’s 71st Scientific Sessions®.
At a joint American Diabetes Association/The Lancet symposium held during Scientific Sessions, researchers presented findings from two randomized European studies: One that explored whether there was additional benefit to adding exercise to diet when treating those newly diagnosed with type 2 diabetes, and one that asked whether more intensive early treatment for screening-detected diabetes would reduce cardiovascular episodes and mortality compared to routine care employed after diagnosis.
ACTID: During First Year of Diagnosis, Put Effort into Changing Diet
In the Early Activity in Diabetes Trial (ACTID) conducted in the U.K., researchers found that, for people newly diagnosed with type 2 diabetes, the inclusion of an intensive dietary intervention (encouraging participants to lose 5-10 percent of body weight, in consultation with a dietitian) resulted in the same improvements in glycemic control, weight loss, cholesterol and triglyceride levels as making changes in both diet and physical activity levels (brisk walking for 30 minutes, five times per week).
The groups that had diet or diet plus exercise each experienced roughly a 10 percent improvement in glycemic control, cholesterol and triglyceride levels as compared to the group that had routine care. The intervention groups also lost about 4 percent of body weight, compared to no weight loss or slight weight gain in the routine care group. The routine care group was also three times more likely than the other groups to start on diabetes medication prior to the end of the study.
In interviews with the researchers, participants said they preferred incorporating both dietary changes and exercise into their lifestyles, lead researcher Rob Andrews, MB, ChB, PhD, Senior Lecturer, University of Bristol, said.
“They found diet alone quite negative,” he said. One reason they might not have seen an additional benefit from exercise, he added, “is because people often make a trade. That is, if they go to the gym, then they feel as if they can have a treat. That could be why we saw no difference in the weight loss for the diet plus exercise group.”
“Getting people to exercise is quite difficult, and can be expensive,” Andrews further explained. “What this study tells us is that if you only have a limited amount of money, in that first year of diagnosis, you should focus on getting the diet right.”
Future research, he stated, should focus on whether adding exercise later in diabetes duration would make more of a difference. “Glycemic control gets worse over time,” he said. “In the early stages, people tend to make rapid improvements and then it stays the same for a while. Adding exercise later might provide another boost in control whereas it wouldn’t early on.”
ADDITION-Europe: Intensive Treatment Brings Slight Improvement in Reducing Cardio Risk Factors
The Anglo-Danish-Dutch study of Intensive Treatment in People with Screen Detected Diabetes in Primary Care (ADDITION-Europe) was a two-phased, randomized trial that screened nearly half a million people for type 2 diabetes in Denmark, the Netherlands and the U.K., and then randomly assigned the 3,057 participants diagnosed with type 2 into intensive multifactorial treatment or routine diabetes care groups who received care in a family practice setting.
Health care teams in the intensive treatment group were encouraged to recommend lifestyle changes (such as an increase in physical activity levels, change in diet and smoking cessation), aspirin treatment and intensive medication treatment for blood pressure, blood glucose and lipids. Health care teams in the routine care group received no follow-up support and were told to follow national guidelines for lifestyle advice and medical treatment of blood pressure, blood glucose and lipids.
Patients in the intensive treatment group achieved modestly greater improvements in cardiovascular risk factors as compared to the routine treatment group. No statistically significant differences were seen in rates of myocardial infarction, stroke, cardiovascular deaths or revascularization, although there was a trend toward reductions in cardiovascular risk. The differences were greatest in the reduction of risk for myocardial infarction and smallest in reducing the risk for stroke.
However, Torsten Lauritzen, MD, chairman of the study’s steering committee, stated the reduction in cardiovascular disease risk factors after five years for all who had entered the study was “quite remarkable.”
“Family physicians in the routine care group did a much better job than we expected,” he said. “Even in that group, there was a clinically significant reduction in blood pressure and cholesterol levels, and small reductions in blood glucose levels and weight were maintained over five years.”
For example, those in the routine care group saw a drop in blood pressure levels from 150 mmHg to 138 mmHg, and those in the intensive group saw a drop from 149 mmHg to 135 mmHg. In terms of cholesterol, those in the routine care group saw a drop from 5.6 mmol/liter to 4.4 mmol/liter and those in the intensive group a drop from 5.5 mmol/liter to 4.2 mmol/liter.
What they learned, Lauritzen said, is that “high risk screening was associated with important reductions in cardiovascular risk factors and a slight additional benefit from receiving more intensive treatment earlier in people with type 2 diabetes.”
“In Europe, people are not offered systematic screening for type 2 diabetes routinely,” he said. “So this study adds to the evidence that early detection and treatment is beneficial and may be useful in terms of encouraging high risk screening in the general population.”
Currently, the Association recommends that all adults aged 45 years and older be considered for diabetes screening by their health care provider every 3 years. Those who are overweight or obese, or who have one or more risk factors for type 2 diabetes, should be tested regardless of age.
Joint ADA/The Lancet Symposium Saturday June 25, 8-10 a.m. PDT
The Early ACTID Trial 8 a.m. PDT
ADDITION-Europe 9 a.m. PDT
The American Diabetes Association is leading the fight to Stop Diabetes and its deadly consequences and fighting for those affected by diabetes. The Association funds research to prevent, cure and manage diabetes; delivers services to hundreds of communities; provides objective and credible information; and gives voice to those denied their rights because of diabetes. Founded in 1940, our mission is to prevent and cure diabetes and to improve the lives of all people affected by diabetes. For more information please call the American Diabetes Association at 1-800-DIABETES (1-800-342-2383) or visit www.diabetes.org. Information from both these sources is available in English and Spanish.
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