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Research ArticleOriginal Research

Long-Term Effect of Population Screening for Diabetes on Cardiovascular Morbidity, Self-Rated Health, and Health Behavior

Justin B. Echouffo-Tcheugui, Rebecca K. Simmons, A. Toby Prevost, Kate M. Williams, Ann-Louise Kinmonth, Nicholas J. Wareham and Simon J. Griffin
The Annals of Family Medicine March 2015, 13 (2) 149-157; DOI: https://doi.org/10.1370/afm.1737
Justin B. Echouffo-Tcheugui
1MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
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Rebecca K. Simmons
1MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
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A. Toby Prevost
2Department of Primary Care and Public Health Sciences, School of Medicine, King’s College London, London, United Kingdom
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Kate M. Williams
3The Primary Care Unit, Cambridge Institute of Public Health, Cambridge, United Kingdom
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Ann-Louise Kinmonth
3The Primary Care Unit, Cambridge Institute of Public Health, Cambridge, United Kingdom
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Nicholas J. Wareham
1MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
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Simon J. Griffin
1MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
3The Primary Care Unit, Cambridge Institute of Public Health, Cambridge, United Kingdom
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  • For correspondence: sjg49@medschl.cam.ac.uk
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Abstract

PURPOSE There is limited trial evidence concerning the long-term effects of screening for type 2 diabetes on population morbidity. We examined the effect of a population-based diabetes screening program on cardiovascular morbidity, self-rated health, and health-related behaviors.

METHODS We conducted a pragmatic, parallel-group, cluster-randomized controlled trial of diabetes screening (the ADDITION-Cambridge study) including 18,875 individuals aged 40 to 69 years at high risk of diabetes in 32 general practices in eastern England (27 practices randomly allocated to screening, 5 to no-screening for control). Of those eligible for screening, 466 (2.9%) were diagnosed with diabetes. Seven years after randomization, a random sample of patients was sent a postal questionnaire: 15% from the screening group (including diabetes screening visit attenders and non-attenders) and 40% from the no-screening control group. Self-reported cardiovascular morbidity, self-rated health (using the SF-8 Health Survey and EQ-5D instrument), and health behaviors were compared between trial groups using an intention-to-screen analysis.

RESULTS Of the 3,286 questionnaires mailed out, 1,995 (61%) were returned, with 1,945 included in the analysis (screening: 1,373; control: 572). At 7 years, there were no significant differences between the screening and control groups in the proportion of participants reporting heart attack or stroke (OR = 0.90, 95% CI, 0.71–1.15); SF-8 physical health summary score as an indicator of self-rated health status (β −0.33, 95% CI, −1.80 to 1.14); EQ-5D visual analogue score (β: 0.80, 95% CI, −1.28 to 2.87); total physical activity (β 0.50, 95% CI, −4.08 to 5.07); current smoking (OR 0.97, 95% CI, 0.72 to 1.32); and alcohol consumption (β 0.14, 95% CI, −1.07 to 1.35).

CONCLUSIONS Invitation to screening for type 2 diabetes appears to have limited impact on population levels of cardiovascular morbidity, self-rated health status, and health behavior after 7 years.

  • diabetes
  • screening
  • cardiovascular morbidity
  • self-rated health
  • health behavior
  • ADDITION-Cambridge
  • Abbreviations

    ADDITION
    Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen Detected Diabetes in Primary Care
    • Received for publication April 3, 2014.
    • Revision received September 13, 2014.
    • Accepted for publication October 10, 2014.
    • © 2015 Annals of Family Medicine, Inc.
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    Long-Term Effect of Population Screening for Diabetes on Cardiovascular Morbidity, Self-Rated Health, and Health Behavior
    Justin B. Echouffo-Tcheugui, Rebecca K. Simmons, A. Toby Prevost, Kate M. Williams, Ann-Louise Kinmonth, Nicholas J. Wareham, Simon J. Griffin
    The Annals of Family Medicine Mar 2015, 13 (2) 149-157; DOI: 10.1370/afm.1737

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    Long-Term Effect of Population Screening for Diabetes on Cardiovascular Morbidity, Self-Rated Health, and Health Behavior
    Justin B. Echouffo-Tcheugui, Rebecca K. Simmons, A. Toby Prevost, Kate M. Williams, Ann-Louise Kinmonth, Nicholas J. Wareham, Simon J. Griffin
    The Annals of Family Medicine Mar 2015, 13 (2) 149-157; DOI: 10.1370/afm.1737
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    Subjects

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    Keywords

    • diabetes
    • screening
    • cardiovascular morbidity
    • self-rated health
    • health behavior
    • ADDITION-Cambridge

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