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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe issue of intensive diabetes therapy became a bit more perplexing after the latest results of the Anglo-Danish-Dutch Study of Intensive Treatment. In People with Screen Detected Diabetes in Primary Care [ADDITION; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00237549\u0026amp;atom=%2Fspmdc%2F10%2F9%2F26.1.atom\u0022\u003ENCT00237549\u003C\/a\u003E] trial found no significant differences in overall cardiovascular events between such care and the routine management of patients with screen-detected diabetes.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes \u0026amp; Endocrinology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe issue of intensive diabetes therapy became a bit more perplexing after the latest results of the ADDITION (Anglo-Danish-Dutch Study of Intensive Treatment. In People with Screen Detected Diabetes in Primary Care; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00237549\u0026amp;atom=%2Fspmdc%2F10%2F9%2F26.1.atom\u0022\u003ENCT00237549\u003C\/a\u003E) trial found no significant differences in overall cardiovascular (CV) events between such care and the routine management of patients with screen-detected diabetes.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ESimon J. Griffin, DM, Medical Research Council Epidemiology Unit, Cambridge, UK, presented the latest findings of the 3000-patient multifactorial trial. The trial was designed to evaluate various stepped screening programs to identify diabetes in at-risk individuals; determine whether primary care practices could provide intensive therapy; and assess the differences between intensive and routine management of diabetes over 5 years, based on continually updated clinical guidelines.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe trial was conducted in three countries: The Netherlands, the UK, and Denmark. Most participants were obese and had high blood pressure (\u0026gt;120\/80 mm Hg) and a median HbA1C of 6.6% upon entry. The primary endpoint was a composite of the first CV event, including CV mortality and morbidity (nonfatal myocardial infarction or nonfatal stroke), revascularization, and nontraumatic amputation.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EGeneral practitioners in the intensive intervention arm were encouraged to provide education on lifestyle changes that were designed to reduce their patients\u0027 CV risk and improve glycemic levels, and treatment started once HbA1C levels reached \u22656.5%, blood pressure was \u0026gt;120\/80 mm Hg, and\/or total cholesterol was \u0026gt;3.5 mmol\/L. Physicians in this arm also received practice-based education.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003ERoutine care was based on national guidelines. Over time, it is important to note that the national guidelines changed and became more similar to the intensive treatment guidelines, with more intensive goals for blood pressure, cholesterol, and HbA1C levels. In fact, Prof. Griffin noted that this congruence of treatment goals was a possible reason for the lack of significant effects that were associated with intensive treatment.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EBoth groups demonstrated improvements in CV risk factors during the study, with the intensive treatment arm demonstrating significant, albeit modest, greater improvements in risk factors and achievement of treatment targets. Rates of CV events in both groups over 5 years were lower than expected (7.2% [intensive] vs 8.5% [control]; HR, 0.83; 95% CI, 0.65 to 1.05; p=0.12). An analysis from William Herman, MD, University of Michigan, Ann Arbor, Michigan, USA, postulated that had the patients in the trial not been screened, diagnosed with diabetes, and treated, the composite endpoint would have doubled, regardless of the type of care that was provided.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThere was no increased mortality in the intensive treatment arm, though such increases were seen in other large diabetes trials that assessed the role of intensive treatment in CV risk.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2010 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/10\/9\/26.1.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmo4d\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}