Long-term effects of intensive multifactorial treatment on aortic stiffness and central hemodynamics after 13 years with screen-detected type 2 diabetes: the ADDITION-Denmark trial

Lasse Bjerg, Esben Laugesen, Signe Toft Andersen, Jonas Frey Rosborg, Morten Charles, Dorte Vistisen, Daniel R Witte, Lasse Bjerg, Esben Laugesen, Signe Toft Andersen, Jonas Frey Rosborg, Morten Charles, Dorte Vistisen, Daniel R Witte

Abstract

Background: Peripheral and central hemodynamic indices are modifiable by lifestyle and medical intervention. We aimed to determine the long-term effect of intensive multifactorial treatment on peripheral and central hemodynamic indices among people with screen-detected diabetes.

Methods: Between 2001 and 2006, people with screen-detected type 2 diabetes were included in the Anglo-Danish-Dutch study of Intensive Treatment of Diabetes in Primary Care (ADDITION) trial (NCT00237549, ClinicalTrials.gov). In the Danish arm, participants were invited to a clinical examination in 2015-2016, 13 years after inclusion and 8 years after trial-end. Out of 586 eligible participants who attended the clinical examination, 411 had a valid examination of central and peripheral hemodynamic indices (242 received intensive treatment and 169 received routine care). Carotid-femoral pulse wave velocity (cfPWV), central blood pressure and augmentation index were assessed by applanation tonometry. We used mixed-effect models to examine the intervention effect adjusting for cluster randomization and heart rate.

Results: Randomization to intensive treatment during the trial-period was associated with a 0.58 m/s lower cfPWV (95% CI - 1.09 to - 0.06) at follow-up. Adjustment for blood pressure attenuated the association. Differences between intervention groups for central augmentation index were - 1.25% (95% CI: - 3.28 to 0.78), central pulse pressure - 1.74 mmHg (95% CI - 4.79 to 1.31), central systolic blood pressure - 3.06 mmHg (- 7.08 to 0.96), and central diastolic blood pressure - 1.70 mmHg (- 3.74 to 0.34).

Conclusions: Intensive multifactorial treatment of screen-detected type 2 diabetes has a sustained positive effect on aortic stiffness measured by cfPWV. Although all estimates pointed in favor of intensive treatment, we observed no clear beneficial effect on other hemodynamic indices.

Keywords: Multifactorial treatment; Pulse wave velocity; Type 2 diabetes.

Conflict of interest statement

D.R.W and D.V own shares in Novo Nordisk A/S. D.V has received research funding from Boehringer Ingelheim and Bayer A/S. M.C reports receiving lecture and honorarium fees from Novo Nordisk A/S and Boehringer Ingelheim A/S. No further potential conflicts of interest relevant to this article are reported.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flow of the included study sample

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