, Volume 54, Issue 6, pp 1318-1326
Date: 22 Feb 2011

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

Abstract

Aims/hypothesis

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.

Methods

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).

Results

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.

Conclusion/interpretation

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.

Trial registration

ClinicalTrials.gov NCT 00237549.

Funding

The study received unrestricted grants from Novo Nordisk, Novo Nordisk Scandinavia, Astra Denmark, Pfizer Denmark, GlaxoSmithKline Pharma Denmark, Servier Denmark and HemoCue Denmark.