Long-term effects of intensive multifactorial treatment on aortic stiffness and central hemodynamics after 13 years with screen-detected type 2 diabetes: the ADDITION-Denmark trial

Lasse Bjerg; Esben Laugesen; Signe Toft Andersen; Jonas Frey Rosborg; Morten Charles; Dorte Vistisen; Daniel R. Witte

doi:10.1186/s13098-022-00890-1

Long-term effects of intensive multifactorial treatment on aortic stiffness and central hemodynamics after 13 years with screen-detected type 2 diabetes: the ADDITION-Denmark trial

Lasse Bjerg^*
, Esben Laugesen
, Signe Toft Andersen
, Jonas Frey Rosborg
, Morten Charles
, Dorte Vistisen
, Daniel R. Witte

^*Corresponding author af dette arbejde

Biostatistisk afdeling

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

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Abstract

Background Peripheral and central hemodynamic indices are modifiable by lifestyle and medical intervention. We aimed to determine the long-term effect of intensive multifactorial treatment on peripheral and central hemodynamic indices among people with screen-detected diabetes. Methods Between 2001 and 2006, people with screen-detected type 2 diabetes were included in the Anglo-Danish-Dutch study of Intensive Treatment of Diabetes in Primary Care (ADDITION) trial (NCT00237549, ClinicalTrials.gov). In the Danish arm, participants were invited to a clinical examination in 2015-2016, 13 years after inclusion and 8 years after trial-end. Out of 586 eligible participants who attended the clinical examination, 411 had a valid examination of central and peripheral hemodynamic indices (242 received intensive treatment and 169 received routine care). Carotid-femoral pulse wave velocity (cfPWV), central blood pressure and augmentation index were assessed by applanation tonometry. We used mixed-effect models to examine the intervention effect adjusting for cluster randomization and heart rate. Results Randomization to intensive treatment during the trial-period was associated with a 0.58 m/s lower cfPWV (95% CI - 1.09 to - 0.06) at follow-up. Adjustment for blood pressure attenuated the association. Differences between intervention groups for central augmentation index were - 1.25% (95% CI: - 3.28 to 0.78), central pulse pressure - 1.74 mmHg (95% CI - 4.79 to 1.31), central systolic blood pressure - 3.06 mmHg (- 7.08 to 0.96), and central diastolic blood pressure - 1.70 mmHg (- 3.74 to 0.34). Conclusions Intensive multifactorial treatment of screen-detected type 2 diabetes has a sustained positive effect on aortic stiffness measured by cfPWV. Although all estimates pointed in favor of intensive treatment, we observed no clear beneficial effect on other hemodynamic indices.

Originalsprog	Engelsk
Artikelnummer	116
Tidsskrift	Diabetology & Metabolic Syndrome
Vol/bind	14
Udgave nummer	1
Antal sider	10
ISSN	1758-5996
DOI	https://doi.org/10.1186/s13098-022-00890-1
Status	Udgivet - 2022

Finansiering

ADDITION-Denmark was funded by the National Health Services in the former counties of Copenhagen, Aarhus, Ringkobing, Ribe, and South Jutland in Denmark; the Danish Council for Strategic Research; the Danish Research Foundation for General Practice; the Novo Nordisk Foundation; the Danish Center for Evaluation and Health Technology Assessment; the Danish National Board of Health; the Danish Medical Research Council; the Aarhus University Research Foundation; Novo Nordisk Scandinavia AB; Novo Nordisk UK; ASTRA Denmark; Pfizer Denmark; GlaxoSmithKline Pharma Denmark; Servier Denmark A/S; and HemoCue Denmark A/S. The International Diabetic Neuropathy Consortium research program, which is supported by the Novo Nordisk Foundation with a Novo Nordisk Foundation Challenge Programme grant (NNF14OC0011633), supported the clinical examination at follow-up. Assessment of PWV is funded by: Steno Innovation Funds 2014. Project Grand: Effect of intensive multifactorial treatment on changes in metabolomic profile and aortic stiffening. The study sponsor/funder was not involved in the design of the study; the collection, analysis, and interpretation of data; writing the report; and did not impose any restrictions regarding the publication of the report.

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10.1186/s13098-022-00890-1Licens: CC BY

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Citationsformater

Bjerg, L., Laugesen, E., Andersen, S. T., Rosborg, J. F., Charles, M., Vistisen, D., & Witte, D. R. (2022). Long-term effects of intensive multifactorial treatment on aortic stiffness and central hemodynamics after 13 years with screen-detected type 2 diabetes: the ADDITION-Denmark trial. Diabetology & Metabolic Syndrome, 14(1), Artikel 116. https://doi.org/10.1186/s13098-022-00890-1

Long-term effects of intensive multifactorial treatment on aortic stiffness and central hemodynamics after 13 years with screen-detected type 2 diabetes: the ADDITION-Denmark trial. / Bjerg, Lasse; Laugesen, Esben; Andersen, Signe Toft et al.
I: Diabetology & Metabolic Syndrome, Bind 14, Nr. 1, 116, 2022.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Bjerg, L, Laugesen, E, Andersen, ST, Rosborg, JF, Charles, M, Vistisen, D & Witte, DR 2022, 'Long-term effects of intensive multifactorial treatment on aortic stiffness and central hemodynamics after 13 years with screen-detected type 2 diabetes: the ADDITION-Denmark trial', Diabetology & Metabolic Syndrome, bind 14, nr. 1, 116. https://doi.org/10.1186/s13098-022-00890-1

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title = "Long-term effects of intensive multifactorial treatment on aortic stiffness and central hemodynamics after 13 years with screen-detected type 2 diabetes: the ADDITION-Denmark trial",

abstract = "Background Peripheral and central hemodynamic indices are modifiable by lifestyle and medical intervention. We aimed to determine the long-term effect of intensive multifactorial treatment on peripheral and central hemodynamic indices among people with screen-detected diabetes. Methods Between 2001 and 2006, people with screen-detected type 2 diabetes were included in the Anglo-Danish-Dutch study of Intensive Treatment of Diabetes in Primary Care (ADDITION) trial (NCT00237549, ClinicalTrials.gov). In the Danish arm, participants were invited to a clinical examination in 2015-2016, 13 years after inclusion and 8 years after trial-end. Out of 586 eligible participants who attended the clinical examination, 411 had a valid examination of central and peripheral hemodynamic indices (242 received intensive treatment and 169 received routine care). Carotid-femoral pulse wave velocity (cfPWV), central blood pressure and augmentation index were assessed by applanation tonometry. We used mixed-effect models to examine the intervention effect adjusting for cluster randomization and heart rate. Results Randomization to intensive treatment during the trial-period was associated with a 0.58 m/s lower cfPWV (95\% CI - 1.09 to - 0.06) at follow-up. Adjustment for blood pressure attenuated the association. Differences between intervention groups for central augmentation index were - 1.25\% (95\% CI: - 3.28 to 0.78), central pulse pressure - 1.74 mmHg (95\% CI - 4.79 to 1.31), central systolic blood pressure - 3.06 mmHg (- 7.08 to 0.96), and central diastolic blood pressure - 1.70 mmHg (- 3.74 to 0.34). Conclusions Intensive multifactorial treatment of screen-detected type 2 diabetes has a sustained positive effect on aortic stiffness measured by cfPWV. Although all estimates pointed in favor of intensive treatment, we observed no clear beneficial effect on other hemodynamic indices.",

keywords = "Multifactorial treatment, Pulse wave velocity, Type 2 diabetes, PULSE-WAVE VELOCITY, CENTRAL BLOOD-PRESSURE, 10-YEAR FOLLOW-UP, ARTERIAL STIFFNESS, CARDIOVASCULAR-DISEASE, INTERVENTION, MORTALITY, THERAPY, METAANALYSIS, INDIVIDUALS",

author = "Lasse Bjerg and Esben Laugesen and Andersen, \{Signe Toft\} and Rosborg, \{Jonas Frey\} and Morten Charles and Dorte Vistisen and Witte, \{Daniel R.\}",

year = "2022",

doi = "10.1186/s13098-022-00890-1",

language = "English",

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journal = "Diabetology \& Metabolic Syndrome",

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T1 - Long-term effects of intensive multifactorial treatment on aortic stiffness and central hemodynamics after 13 years with screen-detected type 2 diabetes

T2 - the ADDITION-Denmark trial

AU - Bjerg, Lasse

AU - Laugesen, Esben

AU - Andersen, Signe Toft

AU - Rosborg, Jonas Frey

AU - Charles, Morten

AU - Vistisen, Dorte

AU - Witte, Daniel R.

PY - 2022

Y1 - 2022

N2 - Background Peripheral and central hemodynamic indices are modifiable by lifestyle and medical intervention. We aimed to determine the long-term effect of intensive multifactorial treatment on peripheral and central hemodynamic indices among people with screen-detected diabetes. Methods Between 2001 and 2006, people with screen-detected type 2 diabetes were included in the Anglo-Danish-Dutch study of Intensive Treatment of Diabetes in Primary Care (ADDITION) trial (NCT00237549, ClinicalTrials.gov). In the Danish arm, participants were invited to a clinical examination in 2015-2016, 13 years after inclusion and 8 years after trial-end. Out of 586 eligible participants who attended the clinical examination, 411 had a valid examination of central and peripheral hemodynamic indices (242 received intensive treatment and 169 received routine care). Carotid-femoral pulse wave velocity (cfPWV), central blood pressure and augmentation index were assessed by applanation tonometry. We used mixed-effect models to examine the intervention effect adjusting for cluster randomization and heart rate. Results Randomization to intensive treatment during the trial-period was associated with a 0.58 m/s lower cfPWV (95% CI - 1.09 to - 0.06) at follow-up. Adjustment for blood pressure attenuated the association. Differences between intervention groups for central augmentation index were - 1.25% (95% CI: - 3.28 to 0.78), central pulse pressure - 1.74 mmHg (95% CI - 4.79 to 1.31), central systolic blood pressure - 3.06 mmHg (- 7.08 to 0.96), and central diastolic blood pressure - 1.70 mmHg (- 3.74 to 0.34). Conclusions Intensive multifactorial treatment of screen-detected type 2 diabetes has a sustained positive effect on aortic stiffness measured by cfPWV. Although all estimates pointed in favor of intensive treatment, we observed no clear beneficial effect on other hemodynamic indices.

AB - Background Peripheral and central hemodynamic indices are modifiable by lifestyle and medical intervention. We aimed to determine the long-term effect of intensive multifactorial treatment on peripheral and central hemodynamic indices among people with screen-detected diabetes. Methods Between 2001 and 2006, people with screen-detected type 2 diabetes were included in the Anglo-Danish-Dutch study of Intensive Treatment of Diabetes in Primary Care (ADDITION) trial (NCT00237549, ClinicalTrials.gov). In the Danish arm, participants were invited to a clinical examination in 2015-2016, 13 years after inclusion and 8 years after trial-end. Out of 586 eligible participants who attended the clinical examination, 411 had a valid examination of central and peripheral hemodynamic indices (242 received intensive treatment and 169 received routine care). Carotid-femoral pulse wave velocity (cfPWV), central blood pressure and augmentation index were assessed by applanation tonometry. We used mixed-effect models to examine the intervention effect adjusting for cluster randomization and heart rate. Results Randomization to intensive treatment during the trial-period was associated with a 0.58 m/s lower cfPWV (95% CI - 1.09 to - 0.06) at follow-up. Adjustment for blood pressure attenuated the association. Differences between intervention groups for central augmentation index were - 1.25% (95% CI: - 3.28 to 0.78), central pulse pressure - 1.74 mmHg (95% CI - 4.79 to 1.31), central systolic blood pressure - 3.06 mmHg (- 7.08 to 0.96), and central diastolic blood pressure - 1.70 mmHg (- 3.74 to 0.34). Conclusions Intensive multifactorial treatment of screen-detected type 2 diabetes has a sustained positive effect on aortic stiffness measured by cfPWV. Although all estimates pointed in favor of intensive treatment, we observed no clear beneficial effect on other hemodynamic indices.

KW - Multifactorial treatment

KW - Pulse wave velocity

KW - Type 2 diabetes

KW - PULSE-WAVE VELOCITY

KW - CENTRAL BLOOD-PRESSURE

KW - 10-YEAR FOLLOW-UP

KW - ARTERIAL STIFFNESS

KW - CARDIOVASCULAR-DISEASE

KW - INTERVENTION

KW - MORTALITY

KW - THERAPY

KW - METAANALYSIS

KW - INDIVIDUALS

U2 - 10.1186/s13098-022-00890-1

DO - 10.1186/s13098-022-00890-1

M3 - Journal article

C2 - 35978373

SN - 1758-5996

VL - 14

JO - Diabetology & Metabolic Syndrome

JF - Diabetology & Metabolic Syndrome

IS - 1

M1 - 116

ER -