An under-explored phenomenon in diabetes trials: the potential for a spillover effect

In a new article published in PloS ONE (February 2017), Dr Rebecca Simmons, a Danish Diabetes Academy Visiting Professor from the University of Cambridge, worked with colleagues from the Public Health Department at Aarhus University, to address an under-explored phenomenon in diabetes trials - the potential for a spillover effect.

The paper was led by Dr Morten Charles and explored whether training general practitioners (GPs) in intensive treatment of people with screen-detected diabetes led to a spillover effect on treatment and outcomes among people with clinically-diagnosed diabetes. 

THE BENEFIT OF MANAGING CARDIOVASCULAR RISK FACTORS AMONG PEOPLE WITH T2D IS WELL ESTABLISHED, BUT IMPLEMENTING EVIDENCE-BASED TREATMENT IS CHALLENGING

According to Dr Rebecca Simmons, the benefit of managing cardiovascular risk factors among people with type 2 diabetes is well established, but implementing evidence-based treatment is challenging. In the ADDITION trial of intensive treatment of individuals with screen-detected individuals, there was a significant increase in the levels of redeemed cardio-protective medication during follow-up. This was associated with a non-significant 17% risk reduction in cardiovascular events over five years.

"We were interested to see if the education and guidelines that we offered GPs had an impact on the management of people with clinically detected diabetes in the same practices. We used data from national registers in Denmark to investigate this question", Dr. Simmons says. 

STILL ROOM FOR IMPROVEMENT

"We found that there were large and significant increases in redeemed cardio-protective medication among clinically-diagnosed diabetes patients in both the control and the intervention practices over time. After seven years of follow-up, there was no difference in the number of people experiencing a heart attack or stroke, or in the number of people dying, between the two groups. While it is encouraging that GPs improved management of both screen-detected and clinically diagnosed diabetes patients during the trial, there was still room for improvement in prescribing. Only 78% of clinically-diagnosed individuals redeemed glucose-lowering medication by the end of follow-up, suggesting that many patients do not receive care according to current guidelines", Dr. Simmons concludes.

Source: PloS ONE