强化与标准多因素心血管危险因素控制在筛查发现的 2 型糖尿病中的比较：ADDITION-Leicester 研究的 5 年及更长期模拟结局。

Intensive versus standard multifactorial cardiovascular risk factor control in screen-detected type 2 diabetes: 5-year and longer-term modelled outcomes of the ADDITION-Leicester study.

机构信息

Leicester Diabetes Centre, University of Leicester, Leicester, UK.

National Health Service (NHS) Leicester City Clinical Commissioning Group, Leicester, UK.

出版信息

Diabetes Metab Res Rev. 2019 Mar;35(3):e3111. doi: 10.1002/dmrr.3111. Epub 2018 Dec 19.

DOI:10.1002/dmrr.3111

PMID:30521699

Abstract

AIMS

Diabetes treatment algorithms recommend intensive intervention in those with a shorter duration of disease. Screening provides opportunities for earlier multifactorial cardiovascular risk factor control. Using data from the ADDITION-Leicester study (NCT00318032), we estimated the effects of this approach on modelled risk of diabetes-related complications in screen-detected patients.

METHODS

A total of 345 (41% South Asian) people with screen-detected type 2 diabetes were cluster randomised to receive 5 years of (1) intensive multifactorial risk factor intervention or (2) standard treatment according to national guidance. Estimated 10 to 20-year risk of ischaemic heart disease, stroke, congestive cardiac failure, and death was calculated using UK-PDS risk equations.

RESULTS

Compared with standard care, mean treatment differences for intensive management at 5 years were -11.7(95%CI: -15.0, -8.4) and -6.6(-8.8, -4.4) mmHg for systolic and diastolic blood pressure, respectively; -0.27 (-0.66, -0.26) % for HbA1c; and -0.46(-0.66; -0.26), -0.34 (-0.51; -0.18), and -0.19 (-0.28; -0.10) mmol/L for total cholesterol, LDL-cholesterol, and triglycerides, respectively. There was no significant weight gain in the intensive group despite additional medication use. Modelled risks were consistently lower for intensively managed patients. Absolute risk reduction associated with intensive treatment at 10 and 20 years were 3.5% and 6.2% for ischaemic heart disease and 6.3% and 8.8% for stroke. Risk reduction for congestive heart failure plateaued after 15 years at 5.3%. No differences were observed for blindness and all-cause death.

CONCLUSION

Intensive multifactorial intervention in a multi-ethnic population with screen-detected type 2 diabetes results in sustained improvements in modelled ischaemic heart disease, stroke, and congestive cardiac failure.

摘要

目的

糖尿病治疗方案建议对病程较短的患者进行强化干预。筛查为早期多因素心血管危险因素控制提供了机会。利用来自 ADDITION-Leicester 研究（NCT00318032）的数据，我们估计了这种方法对筛查出的患者的糖尿病相关并发症风险模型的影响。

方法

共有 345 名（41%为南亚裔）筛查出的 2 型糖尿病患者按簇随机分配，接受 5 年的（1）强化多因素危险因素干预或（2）根据国家指南进行标准治疗。使用 UK-PDS 风险方程计算缺血性心脏病、中风、充血性心力衰竭和死亡的 10 至 20 年估计风险。

结果

与标准护理相比，强化管理 5 年的平均治疗差异分别为收缩压和舒张压分别为-11.7（95%CI：-15.0，-8.4）和-6.6（-8.8，-4.4）mmHg；HbA1c 为-0.27（-0.66，-0.26）%；总胆固醇、LDL-胆固醇和甘油三酯分别为-0.46（-0.66；-0.26）、-0.34（-0.51；-0.18）和-0.19（-0.28；-0.10）mmol/L。尽管使用了额外的药物，强化组的体重没有明显增加。强化治疗的患者风险模型始终较低。强化治疗 10 年和 20 年时缺血性心脏病和中风的绝对风险降低分别为 3.5%和 6.2%和 6.3%和 8.8%。充血性心力衰竭的风险降低在 15 年后稳定在 5.3%。未观察到失明和全因死亡的差异。