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ADDITION-Cambridge. Objective Assess the impact of a population-based screening program on mortality among people at high risk of undiagnosed diabetes. ADDITION-Cambridge. Study Design Cluster-randomized, controlled trial

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ADDITION-Cambridge

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Addition cambridge

ADDITION-Cambridge

Objective

  • Assess the impact of a population-based screening program on mortality among people at high risk of undiagnosed diabetes


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ADDITION-Cambridge

Study Design

  • Cluster-randomized, controlled trial

  • Study population: 20,184 individuals (mean age 58 years, 64% men) from 32 general practices, who were considered to be at high risk of diabetes based on a validated risk score

  • 27 practices were randomly assigned to a screening group (n=16,047) and 5 practices to a no-screening control group (n=4137)

    • Patients and practitioners in the no-screening group were unaware of the patientsÔÇÖ high-risk status

  • All participants were tagged for mortality at the Office for National Statistics and followed for 10 years


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ADDITION-Cambridge

Primary Analysis

  • Comparison of all-cause mortality rates and CV, cancer, and diabetes-related mortality rates between the screening and control groups

    Findings

  • Over a median follow-up of 9.6 years, 15,089 (94%) of the high-risk individuals in screening practices were invited for screening

    • 11,737 (73.1%) attended

    • 466 (2.9%) were diagnosed with diabetes

  • 4137 subjects were followed in the no-screening practices

  • There were no differences in mortality rates by study group


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ADDITION-Cambridge

Cumulative Incidence Rate


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ADDITION-Cambridge

Mortality Rate by Study Group


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ADDITION-Cambridge

Conclusion

  • The benefits of screening for diabetes may have been overestimated and limited to those who are diagnosed and treated early

  • The benefits of screening might be improved by

    • The detection and management of related CV risk factors alongside assessment of diabetes risk

    • Repeated rounds of screening

    • The identification of non-attenders and strategies to maximize their utilization of screening


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