Article Figures & Data
Figures
- Figure 1
Cumulative hazard of primary outcome following diagnosis of type 2 diabetes by opportunistic targeted screening, compared with clinical diagnosis.
CVD = cardiovascular disease; HR = hazard ratio.
Notes: Cumulative hazard of death from CVD, nonfatal myocardial infarction, or nonfatal stroke, adjusted for age, sex, and the following baseline characteristics: CVD, systolic blood pressure, fasting plasma glucose, and plasma creatinine.
Tables
- Table 1
Characteristics of Patients with Newly Diagnosed Type 2 Diabetes for Opportunistic Targeted Screening (n = 359) and Clinical Diagnosis (n = 206) Groups at Baseline and After Follow-up
Characteristic Baseline Follow-up Opportunistic Targeted Screening Clinical Diagnosis P Value Opportunistic Targeted Screening Clinical Diagnosis P Value Age, mean (SD), y 61.8 (7.8) 59.0 (8.1) <.001 Sex (male), No. (%) 175 (48.7) 118 (57.3) .05 Follow-up, mean (SD), y 7.7 (2.4) 7.1 (2.7) .01 History of macrovascular disease,a No. (%) 88 (24.5) 24 (11.7) <.001 Ischemic heart disease, No. (%) 44 (12.3) 8 (3.9) .001 Myocardial infarction, No. (%) 26 (7.2) 11 (5.3) .38 Stroke, No. (%) 12 (3.3) 3 (1.5) .18 Other, No. (%) 24 (6.7) 11 (5.3) .52 History of microvascular disease,a No. (%) 63 (17.5) 24 (11.7) .06 Retinopathy, No. (%) 1 (0.3) 3 (1.7) .12 Neuropathy, No. (%) 6 (1.7) 8 (3.9) .10 Nephropathy, No. (%) 57 (16.9) 13 (7.1) .002 Blood glucose control FPG, mean (SD), mmol/L 8.8 (2.9) 12.9 (5.0) <.001 7.9 (1.7) 8.2 (2.2) .06 HbA1c, mean (SD),b mmol/mol 55 (17) 74 (28) <.001 51 (10) 54 (12) .001 HbA1c, mean (SD),b % 7.2 (1.6) 8.9 (2.5) <.001 6.8 (0.9) 7.1 (1.1) .001 CVD risk factors Current smoking, No. (%) 66 (19.3) 41 (21.9) .47 45 (13.5) 29 (15.8) .48 Systolic blood pressure, mean (SD), mm Hg 153 (20) 147 (21) .004 145 (18) 144 (17) .59 Diastolic blood pressure, mean (SD), mm Hg 86 (10) 85 (11) .33 80 (10) 81 (9) .16 BMI, mean (SD), kg/m2 30.5 (4.7) 29.7 (5.0) .07 29.9 (4.7) 29.6 (4.6) .51 Total cholesterol, mean (SD), mmol/L 6.0 (1.2) 6.0 (1.4) .38 4.7 (1.1) 4.7 (1.1) .58 LDL cholesterol, mean (SD), mmol/L 3.7 (1.1) 3.8 (1.2) .72 2.6 (1.0) 2.7 (0.9) .86 Plasma creatinine, mean (SD), mmol/L 88.7 (18.1) 84.1 (17.3) .004 89.4 (24.5) 87.4 (19.9) .32 - Table 2
Main Process and Outcome Variables of Care, at Last Follow-up for Opportunistic Targeted Screening (n = 359) and Clinical Diagnosis (n = 206) Groups
Variable Opportunistic Targeted Screening No. (%) Clinical Diagnosis No. (%) P Value Process of care HbA1c recorded 345 (96.1) 196 (95.1) .59 Systolic blood pressure recorded 349 (97.2) 197 (95.6) .32 LDL cholesterol recorded 332 (92.5) 182 (88.3) .10 Eye examination recorded 344 (95.8) 189 (91.7) .04 Foot examination recorded 348 (96.9) 192 (93.2) .04 Outcome of care HbA1c <53 mmol/mol (7.0%) 220 (63.8) 99 (50.5) .003 Systolic blood pressure <140 mm Hg 126 (36.1) 69 (35.0) .80 LDL cholesterol <2.5 mmol/L 159 (47.9) 81 (44.5) .46 Glucose-lowering treatment Diet only 96 (26.7) 34 (16.5) .01 Oral agent(s) 231 (64.3) 147 (71.4) .09 Insulin 19 (5.3) 26 (12.6) .002 Antihypertensive agent(s) 228 (71.2) 90 (52.3) <.001 Lipid-lowering agent(s) 216 (67.7) 109 (63.7) .38 -
HbA1c = hemoglobin A1c; LDL = low-density lipoprotein.
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- Table 3
Events After Diagnosis of Type 2 Diabetes for Opportunistic Targeted Screening (n = 359) and Clinical Diagnosis (n = 206) Groups
Incidence, No. (%) Events Opportunistic Targeted Screening Clinical Diagnosis P Value Unadjusted HR (95% CI)a P Value Adjusted HR (95% CI)a P Value Primary outcomes Major macrovascular eventb 34 (9.5) 21 (10.2) .78 0.84 (0.49-1.44) .52 0.67 (0.36-1.25) .21 CVD death 16 (4.5) 4 (1.9) .16 2.10 (0.70-6.28) .19 1.88 (0.41-8.57) .42 Nonfatal MI 11 (3.1) 11 (5.3) .18 0.54 (0.23-1.25) .15 0.43 (0.18-1.02) .06 Nonfatal stroke 10 (2.8) 9 (4.4) .32 0.57 (0.23-1.40) .22 0.68 (0.23-2.02) .49 Secondary outcomes Microvascular eventb 54 (17.1) 24 (15.2) .59 1.04 (0.64-1.68) .88 0.94 (0.55-1.60) .81 Retinopathy 5 (1.5) 7 (3.9) .08 0.32 (0.10-1.01) .05 0.75 (0.19-3.08) .69 Neuropathy 40 (11.5) 16 (8.3) .25 1.33 (0.74-2.37 ) .34 1.23 ( 0.63 -2.39) .54 Nephropathy 18 (5.5) 10 (5.9) .87 0.86 (0.39-1.85) .69 0.93 (0.38-2.24) .87 Any first CVDc 68 (18.9) 28 (13.6) .10 1.33 (0.86-2.07) .21 1.03 (0.63-1.67) .92 All-cause death 31 (8.6) 22 (10.7) .42 0.73 (0.42-1.26) .26 0.60 (0.31-1.13) .12 Non-CVD death 15 (4.2) 18 (8.7) .03 0.43 (0.22-0.85) .02 0.33 (0.15-0.71) .01 -
CVD = cardiovascular disease; HR = hazard ratio; MI = myocardial infarction.
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↵a Hazard ratios with matching P values compare hazards in type 2 diabetes detected by opportunistic targeted screening with those in clinically diagnosed type 2 diabetes, unadjusted and adjusted for age, sex, and the following baseline characteristics: CVD, systolic blood pressure, fasting plasma glucose, and plasma creatinine.
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↵b Some patients had multiple events.
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↵c Nonfatal MI, nonfatal stroke, heart failure, ischemic heart disease, transient cerebral ischemia, or peripheral arterial disease.
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The Article in Brief
Vascular Outcomes in Patients With Screen-Detected or Clinically Diagnosed Type 2 Diabetes: Diabscreen Study Follow-up
Erwin P. Klein Woolthuis , and colleagues
Background Does treatment of patients with type 2 diabetes detected through screening result in lower vascular event rates when compared with treatment of patients diagnosed by clinical symptoms? This study compares outcomes in family medicine patients with type 2 diabetes diagnosed through these 2 different methods.
What This Study Found Regardless of how type 2 diabetes is diagnosed--whether through clinical diagnosis based on signs and symptoms (eg, excessive thirst and/or urination, fatigue, infections, blurred vision) or using opportunistic targeted screening of high-risk patients (eg, family history of diabetes, history of cardiovascular disease, obesity, hypertension, high cholesterol)--the rate of iillness and death from cardiovascular disease over a 7-year period does not differ significantly. Among 565 patients with newly diagnosed type 2 diabetes, composite primary event rates during follow-up did not differ between the opportunistic targeted screening and clinical diagnosis groups. There are also no significant differences in the separate events rates of deaths from cardiovascular disease, nonfatal heart attacks, and nonfatal strokes.
Implications
- The authors call for future research to investigate the findings in a larger setting and with longer follow-up.
