HbA1c and cardiovascular risk score identify people who may benefit from preventive interventions: a 7 year follow-up of a high-risk screening programme for diabetes in primary care (ADDITION), Denmark
The measurement of HbA1c is suggested as a diagnostic test for diabetes. Screening for diabetes also identifies individuals with elevated cardiovascular risk but who are free of diabetes. This study aims to assess whether screening by HbA1c or glucose measures alone, or in combination with a cardiovascular risk assessment, identifies people who may benefit from preventive interventions, i.e. people with screen detected diabetes and people belonging to groups with excess mortality, during a median follow-up of 7 years.
A population-based, stepwise high-risk screening programme was performed in 193 family practices from 2001 to 2006. Individuals aged between 40 and 69 years (N = 163,185) were sent a diabetes risk questionnaire. Of these, 20,916 people at risk of diabetes were stratified by glucose measures (normal glucose tolerance [NGT], impaired fasting glucose [IFG], impaired glucose tolerance [IGT] and diabetes), HbA1c (<6%; 6.0–6.4%; or ≥6.5%) and cardiovascular risk (heart SCORE <5 or ≥5). People were followed for a median of 7 years or until death. Excess mortality was calculated using the Cox hazard ratio (HR).
SCORE ≥ 5 identified 91.7% (95% CI 91.1–92.3%) of those who might benefit from preventive interventions. SCORE ≥ 5 in combination with HbA1c ≥ 6.0% identified 96.7% (95% CI 96.3–97.0%), compared with 97.6% (95%CI 97.2–97.9%) in combination with glucose measures. Glucose measures or HbA1c alone identified 26.1% (95% CI 25.2–27.0%) and 19.8% (95% CI 19.0–20.6%), respectively.
In a population-based high risk screening programme in primary care, HbA1c ≥ 6.0% combined with an elevated cardiovascular risk assessment (SCORE ≥ 5) can feasibly be used to identify those who may benefit from preventive lifestyle intervention and/or polypharmacy.
ClinicalTrials.gov NCT 00237549.
The study received unrestricted grants from Novo Nordisk, Novo Nordisk Scandinavia, Astra Denmark, Pfizer Denmark, GlaxoSmithKline Pharma Denmark, Servier Denmark and HemoCue Denmark.
- HbA1c and cardiovascular risk score identify people who may benefit from preventive interventions: a 7 year follow-up of a high-risk screening programme for diabetes in primary care (ADDITION), Denmark
Volume 54, Issue 6 , pp 1318-1326
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- All-cause mortality
- Cardiovascular risk
- Type 2 diabetes mellitus
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- Author Affiliations
- 1. Department of General Practice, School of Publich Health, Aarhus University, Bartholins Allé 2, DK 8000, Aarhus C, Denmark
- 2. Steno Diabetes Centre, Gentofte, Denmark
- 3. Institute of Public Health, Research Centre for Quality in Health Care, University of Southern Denmark, Odense, Denmark