Value of intensive treatment for early diabetes questioned

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When early type 2 diabetes is detected by screening, intensive management

doesn't seem to cut the risk of certain complications later on, a Danish

study indicates

" We found no statistically significant effect of intensive multifactorial

treatment on the prevalence of diabetic peripheral neuropathy and peripheral

arterial disease compared with routine care, " the authors reported in

Diabetes Care online August 4.

Dr. Morten , with the School of Public Health, Aarhus University, and

colleagues point out that screening for diabetes is increasingly accepted,

but its value is uncertain.

Earlier this year in The Lancet, some of Dr. ' co-authors on this

paper were among those reporting on the international ADDITION study, in

which intensive management of screen-detected type 2 diabetes yielded a

nonsignificant reduction in cardiovascular events over five years.

The current study focused on 1,533 Danish participants in ADDITION. They

were managed in general practices that were randomized to deliver either

intensive multifactorial treatment or routine care.

Six years after screening, the prevalence of an ankle-brachial index of 0.9

or less was 9.1% in the routine-care arm and 7.3% in the intensive treatment

arm. Similarly, abnormal test results for neuropathy were seen in 34.8% and

30.1% in the routine- and intensive-treatment groups, respectively.

While these differences were not statistically significant, " all observed

risk estimates favored multifactorial intervention at a nonstatistically

significant level, " Dr. and colleagues comment.

They also point out that the prevalence of peripheral neuropathy and

peripheral arterial disease were high, so " clinicians should be aware of

these high prevalences when dealing with patients with screen-detected

diabetes. "

The researchers offered another caveat: " It is conceivable " that when

diabetes is in its initial stages, " a longer duration of intensive treatment

is necessary to observe an effect. "

They added, " A future repeated examination of our participants after a

longer follow-up period will show whether this is the case. "

SOURCE: http://dx.doi.org/10.2337/dc11-0903

Diabetes Care 2011.

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