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Clinical Care/Education/Nutrition
Population-based screen-detected type 2 diabetes mellitus is associated with less need for insulin therapy after 10 years
  1. Rimke C Vos1,2,
  2. Henk den Ouden2,
  3. Lois A Daamen2,
  4. Henk J G Bilo3,
  5. Petra Denig4,
  6. Guy E H M Rutten2
  1. 1Public Health and Primary Care/LUMC-Campus The Hague, LUMC, Leiden, The Netherlands
  2. 2Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
  3. 3Department of Internal Medicine, Isala Klinieken Locatie Weezenlanden, Zwolle, The Netherlands
  4. 4Department of Clinical Pharmacy and Pharmacology, UMCG, Groningen, The Netherlands
  1. Correspondence to Dr Rimke C Vos; r.c.vos{at}lumc.nl

Abstract

Introduction With increased duration of type 2 diabetes, most people have a growing need of glucose-lowering medication and eventually might require insulin. Presumptive evidence is reported that early detection (eg, by population-based screening) and treatment of hyperglycemia will postpone the indication for insulin treatment. A treatment legacy effect of population-based screening for type 2 diabetes of about 3 years is estimated. Therefore, we aim to compare insulin prescription and glycemic control in people with screen-detected type 2 diabetes after 10 years with data from people diagnosed with type 2 diabetes seven (treatment legacy effect) and 10 years before during care-as-usual.

Research design and methods Three cohorts were compared: one screen-detected cohort with 10 years diabetes duration (Anglo-Danish-Dutch study of Intensive Treatment in People with Screen-Detected Diabetes in Primary care (ADDITION-NL): n=391) and two care-as-usual cohorts, one with 7-year diabetes duration (Groningen Initiative to Analyze Type 2 Diabetes Treatment (GIANTT) and Zwolle Outpatient Diabetes project Integrating Available Care (ZODIAC): n=4473) and one with 10-year diabetes duration (GIANTT and ZODIAC: n=2660). Insulin prescription (primary outcome) and hemoglobin A1c (HbA1c) of people with a known diabetes duration of 7 years or 10 years at the index year 2014 were compared using regression analyses.

Results Insulin was prescribed in 10.5% (10-year screen detection), 14.7% (7-year care-as-usual) and 19.0% (10-year care-as-usual). People in the 7-year and 10-year care-as-usual groups had a 1.5 (95% CI 1.0 to 2.1) and 1.8 (95% CI 1.3 to 2.7) higher adjusted odds for getting insulin prescribed than those after screen detection. Lower HbA1c values were found 10 years after screen detection (mean 50.1 mmol/mol (6.7%) vs 51.8 mmol/mol (6.9%) and 52.8 mmol/mol (7.0%)), compared with 7 years and 10 years after care-as-usual (MDadjusted: 1.6 mmol/mol (95% CI 0.6 to 2.6); 0.1% (95% CI 0.1 to 0.2) and 1.8 mmol/mol (95% CI 0.7 to 2.9); and 0.2% (95% CI 0.1 to 0.3)).

Conclusion Population-based screen-detected type 2 diabetes is associated with less need for insulin after 10 years compared with people diagnosed during care-as-usual. Glycemic control was better after screen detection but on average good in all groups.

  • type 2 diabetes
  • insulin
  • primary care/family practice
  • screening
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjdrc-2019-000949

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    Footnotes

    • Contributors GEHMR and RCV designed the study. RCV analyzed the data and drafted the manuscript. RCV and HdO coordinated the data collection of the Anglo-Danish-Dutch study of Intensive Treatment in People with Screen-Detected Diabetes in Primary care-NL data. LAD and HdO were involved in drafting and analysing previous versions of the manuscript. HJGB is responsible for the Zwolle Outpatient Diabetes project Integrating Available Care data and PD for the Groningen Initiative to Analyze Type 2 Diabetes Treatment data. All authors read and approved the final manuscript. RCV is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The Medical Ethical Committee of the University Medical Center Utrecht, the Netherlands, approved the study and all participants gave their informed consent.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request.