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Screening for Type 2 Diabetes – The ADDITION Netherlands Study

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Published Online: Jun 6th 2011 European Endocrinology, 2009; 5:32-7; DOI:
Authors: Guy EHM Rutten, Paul GH Janssen
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To investigate whether early treatment of screening-detected diabetic patients is beneficial, the Anglo–Danish–Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION) has been initiated. A total of 56,978 subjects 50–70 years of age without diabetes from 79 general practices in The Netherlands were invited to participate in a stepwise screening programme. Five hundred and eighty-six participants (1.0%) were diagnosed with type 2 diabetes. The score on the initial risk questionnaire was higher if glucose metabolism was more disturbed. The yield of screening varied widely between practices. A lower yield was not associated with an appropriate practice organisation regarding diabetes care, nor with a speciality of the GP in diabetes. Opportunistic screening in general practice seems preferable to population-based screening. Intensified multifactorial treatment of patients with screening-detected type 2 diabetes in general practice reduced the cardiovascular risk factor levels significantly after just one year without worsening healthrelated quality of life. After three years of follow-up, screened participants without diabetes but with an elevated risk score had comparable cardiovascular event rates to patients with diabetes. Screened individuals without diabetes are at risk of lacking optimal control of cardiovascular risk factors.

Cardiovascular disease, healthcare delivery, impaired glucose tolerance, impaired fasting glucose, primary care, screening, type 2 diabetes

Disclosure and Acknowledgements: The authors are grateful to Professor Ronald Stolk and Dr Kees Gorter for their substantive contributions to the article. The ADDITION Netherlands study is made possible by unrestricted grants from Novo Nordisk, GlaxoSmithKline and Merck.
Received: 6 May 2009 Accepted: 16 June 2009
Correspondence: Guy Rutten, Professor of Diabetology in Primary Care, University Medical Centre Utrecht, Julius Centre for Health Sciences and Primary Care, PO Box 85500, 3508 GA Utrecht, The Netherlands. E:


The prevalence of type 2 diabetes is rapidly increasing. Most people are asymptomatic at diagnosis and the assumption is made that early diagnosis and treatment of type 2 diabetes will be beneficial, although definitive evidence is lacking.

The prevalence of type 2 diabetes is rapidly increasing. Most people are asymptomatic at diagnosis and the assumption is made that early diagnosis and treatment of type 2 diabetes will be beneficial, although definitive evidence is lacking. The American Diabetes Association stated that there is sufficient indirect evidence to justify opportunistic screening in a clinical setting.3 Recently, the International Diabetes Federation also recommended opportunistic screening.In The Netherlands, the Dutch College of General Practitioners recommends opportunistic screening (case-finding) for diabetes in people at risk of type 2 diabetes. To investigate whether early treatment of patients with screening-detected diabetes is beneficial, the Anglo–Danish– Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION) has been initiated. ADDITION is a multicentre randomised controlled trial that consists of a screening study and a subsequent intervention trial with a follow-up of five years. In the screening study, the feasibility of identifying persons with type 2 diabetes is evaluated. In the intervention study (a single-blind, multipractice trial with practicelevel randomisation), the effects of routine care in general practice according to national guidelines are compared with those of an intensified, multifactorial treatment on cardiovascular mortality and morbidity (non-fatal myocardial infarction and non-fatal stroke), revascularisation and amputations.

This article describes the results of population-based screening for diabetes in The Netherlands and the associations of the yield of the screening with characteristics of general practitioners (GPs) and practices. Furthermore, we report on the one-year results of the intervention trial. Finally, we followed people in different glucose regulation categories over three years regarding the extent of healthcare utilisation and the risk of cardiovascular disease (CVD).

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