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Value of early, intensive diabetes treatment questionable

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Intensive treatment of type 2 diabetes that’s detected early through screening does not seem to reduce rates of subsequent complications, 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 conclude in their report in Diabetes Care online August 4.

Dr. Morten Charles, with the School of Public Health, Aarhus University, and colleagues point out that screening for diabetes is increasingly accepted, but the value is uncertain. The ADDITION study found that intensive management of screen-detected type 2 diabetes yielded a nonsignificant reduction in cardiovascular events over 5 years.

In the current study, the team analyzed data from that study to look at the effect of early detection and intensive multifactorial treatment on the development of diabetic peripheral neuropathy (DPN) and peripheral arterial disease (PAD) in 1533 patients with screen-detected diabetes. 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% of the two groups, respectively.

While these differences were not statistically significant, “all observed risk estimates favored multifactorial intervention at a nonstatistically significant level,” Dr. Charles and colleagues comment.

They also point out that the prevalence of PAD and DPN were high, so “clinicians should be aware of these high prevalences when dealing with patients with screen-detected diabetes.”

Prevalence of Neuropathy and Peripheral Arterial Disease and the Impact of Treatment in People With Screen-Detected Type 2 Diabetes
Diabetes Care 2011.