Journal
DIABETOLOGIA
Volume 56, Issue 1, Pages 101-108Publisher
SPRINGER
DOI: 10.1007/s00125-012-2744-5
Keywords
ADDITION; Cardiac autonomic neuropathy; Diabetic neuropathy; Heart rate variability; Prevalence; Screen-detected diabetes; Trial
Categories
Funding
- National Health Service of Copenhagen
- National Health Service of Aarhus
- National Health Service of Ringkobing
- National Health Service of Ribe
- National Health Service of South Jutland in Denmark
- Danish Council for Strategic Research
- Danish Research Foundation for General Practice
- Novo Nordisk Foundation
- Danish Centre for Evaluation and Health Technology Assessment
- National Board of Health
- Danish Medical Research Council
- Aarhus University Research Foundation
- Novo Nordisk AS
- Novo Nordisk Scandinavia AB
- Novo Nordisk UK
- ASTRA Denmark
- Pfizer Denmark
- GlaxoSmithKline Pharma Denmark
- Servier Denmark A/S
- HemoCue Denmark A/S
- Novo Nordisk
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There is limited evidence on how multifactorial treatment improves outcomes of diabetes when initiated in the lead time between detection by screening and diagnosis in routine clinical practice. Cardiac autonomic neuropathy (CAN) in people with diabetes indicates widespread damage to the autonomic nervous system, which may severely affect health and quality of life. We examined effects of early detection and subsequent intensive treatment of type 2 diabetes in primary care on the prevalence of CAN at the 6-year follow-up examination in a pragmatic cluster-randomised parallel group trial. One hundred and ninety general practices were randomised to deliver either intensive multifactorial treatment (IT) or routine care (RC) as recommended by national guidelines to patients with type 2 diabetes, identified through a stepwise screening programme in the primary care setting. 1533 people (IT, n = 910; RC, n = 623) were identified and included. At the 6-year follow-up examination, measures of CAN were applied in an unselected subsample of 777 participants using heart rate variability analysis and standard tests of CAN. At the 6-year follow-up examination, the prevalence of early CAN was 15.1% in the RC group and 15.5% in the IT group, while manifest CAN was present in 7.1% and 7.3%, respectively. We found no statistically significant effect of intensive treatment on the prevalence of CAN compared with routine care. In the Danish arm of the ADDITION Study, signs of CAN were highly prevalent 6 years after a screening-based diagnosis of type 2 diabetes. Intensive multifactorial treatment did not significantly affect the prevalence of CAN compared with routine care. However, at follow-up the level of medication was also high in the RC group.
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