Prevalence of neuropathy and peripheral arterial disease and the impact of treatment in people with screen-detected type 2 diabetes: the ADDITION-Denmark study

Morten Charles, Niels Ejskjaer, Daniel R Witte, Knut Borch-Johnsen, Torsten Lauritzen, Annelli Sandbaek, Morten Charles, Niels Ejskjaer, Daniel R Witte, Knut Borch-Johnsen, Torsten Lauritzen, Annelli Sandbaek

Abstract

Objective: There is limited evidence on how intensive multifactorial treatment (IT) improves outcomes of diabetes when initiated in the lead time between detection by screening and diagnosis in routine clinical practice. We examined the effects of early detection and IT of type 2 diabetes in primary care on the prevalence of diabetic peripheral neuropathy (DPN) and peripheral arterial disease (PAD) 6 years later in a pragmatic, cluster-randomized parallel group trial.

Research design and methods: A stepwise screening program in 190 general practices in Denmark was used to identify 1,533 people with type 2 diabetes. General practices were randomized to deliver either IT or routine care (RC) as recommended through national guidelines. Participants were followed for 6 years and measures of DPN and PAD were applied.

Results: We found no statistically significant effect of IT on the prevalence of DPN and PAD compared with RC. The prevalence of an ankle brachial index ≤0.9 was 9.1% (95% CI 6.0-12.2) in the RC arm and 7.3% (5.0-9.6) in the IT arm. In participants tested for vibration detection threshold and light touch sensation, the prevalence of a least one abnormal test was 34.8% (26.7-43.0) in the RC arm and 30.1% (24.1-36.1) in the IT arm.

Conclusions: In a population with screen-detected type 2 diabetes, we did not find that screening followed by IT led to a statistically significant difference in the prevalence of DPN and PAD 6 years after diagnosis. However, treatment levels were high in both groups.

Trial registration: ClinicalTrials.gov NCT00237549.

Figures

Figure 1
Figure 1
Effect of IT in general practice as compared with RC expressed in odds ratios taking cluster effect into account. Light touch sensation tested with 10 g monofilament. MNSI Qst, MNSI questionnaire ≥7; pain, distal peripheral diabetic pain defined by self-reported bilateral pain distal from knees or elbows.

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