https://lra.le.ac.uk/bitstream/2381/23715/1/1-s2.0-S0140673611606983-main.pdf

Effect of early intensive multifactorial therapy on 5-year cardiovascular outcomes in individuals with type 2 diabetes detected by screening (ADDITION-Europe): a cluster-randomised trial

Periodontitis and diabetes are complex chronic diseases, linked by an established bidirectional relationship. Risk for periodontitis is increased two to three times in people with diabetes compared to individuals without, and the level of glycaemic control is key in determining risk. In people who do not have diabetes, periodontitis is associated with higher glycated haemoglobin (HbA1c) and fasting blood glucose levels, and severe periodontitis is associated with increased risk of developing diabetes. In people with type 2 diabetes, periodontitis is associated with higher HbA1c levels and worse diabetes complications. Treatment of periodontitis in people with diabetes has been shown to result in improved glycaemic control, with HbA1c reductions of 3-4 mmol/mol (0.3-0.4%) in the short term (3-4 months) post-treatment. Given that treatment of periodontitis results in clinically relevant reductions in HbA1c, the dental team has an important role in the management of patients with diabetes. Improved interprofessional working in relation to diabetes and periodontitis has been advocated by professional and scientific organisations, though practical and systemic barriers make this challenging. This paper reviews current evidence linking periodontitis and diabetes, and considers the role of the dental team in the wider context of management of patients with diabetes and periodontitis.

Periodontitis and diabetes

For article see page 5289



This work was supported by the U.S. Department of Veterans Affairs (Cincinnati Veterans Affairs Medical Center, and Merit Award 5I01CX000121-02), the Ursich Family Award, and the Michigan Diabetes Research and Training Center (National Institutes of Health Grant DK020572).



Disclosure Summary: R.M.C. has served as a consultant for Roche Diagnostics. S.H. and W.H.H. have nothing to declare.



Abbreviations: FPG, Fasting plasma glucose; HbA1c, hemoglobin A1c; RBC, red blood cell.

/pdf/hba1c-for-the-diagnosis-of-diabetes-and-prediabetes-is-it-3fwjl55idf.pdf

HbA1c for the Diagnosis of Diabetes and Prediabetes: Is It Time for a Mid-Course Correction?

Objective To investigate the relationship between neighbourhood greenspace and type 2 diabetes. Design Cross-sectional. Setting 3 diabetes screening studies conducted in Leicestershire, UK in 2004–2011. The percentage of greenspace in the participant9s home neighbourhood (3 km radius around home postcode) was obtained from a Land Cover Map. Demographic and biomedical variables were measured at screening. Participants 10 476 individuals (6200 from general population; 4276 from high-risk population) aged 20–75 years (mean 59 years); 47% female; 21% non-white ethnicity. Main outcome measure Screen-detected type 2 diabetes (WHO 2011 criteria). Results Increased neighbourhood greenspace was associated with significantly lower levels of screen-detected type 2 diabetes. The ORs (95% CI) for screen-detected type 2 diabetes were 0.97 (0.80 to 1.17), 0.78 (0.62 to 0.98) and 0.67 (0.49 to 0.93) for increasing quartiles of neighbourhood greenspace compared with the lowest quartile after adjusting for ethnicity, age, sex, area social deprivation score and urban/rural status (Ptrend=0.01). This association remained on further adjustment for body mass index, physical activity, fasting glucose, 2 h glucose and cholesterol (OR (95% CI) for highest vs lowest quartile: 0.53 (0.35 to 0.82); Ptrend=0.01). Conclusions Neighbourhood greenspace was inversely associated with screen-detected type 2 diabetes, highlighting a potential area for targeted screening as well as a possible public health area for diabetes prevention. However, none of the risk factors that we considered appeared to explain this association, and thus further research is required to elicit underlying mechanisms. Trial registration number This study uses data from three studies (NCT00318032, NCT00677937, NCT00941954).

https://bmjopen.bmj.com/content/bmjopen/4/12/e006076.full.pdf

The association between neighbourhood greenspace and type 2 diabetes in a large cross-sectional study

A community based primary prevention programme for type 2 diabetes integrating identification and lifestyle intervention for prevention: the Let's Prevent Diabetes cluster randomised controlled trial.

Earlier diagnosis followed by multi-factorial cardiovascular risk intervention may improve outcomes in Type 2 Diabetes Mellitus (T2DM). Latent phase identification through screening requires structured, appropriately targeted population-based approaches. Providers responsible for implementing screening policy await evidence of clinical and cost effectiveness from randomised intervention trials in screen-detected T2DM cases. UK South Asians are at particularly high risk of abnormal glucose tolerance and T2DM. To be effective national screening programmes must achieve good coverage across the population by identifying barriers to the detection of disease and adapting to the delivery of earlier care. Here we describe the rationale and methods of a systematic community screening programme and randomised controlled trial of cardiovascular risk management within a UK multiethnic setting (ADDITION-Leicester). A single-blind cluster randomised, parallel group trial among people with screen-detected T2DM comparing a protocol driven intensive multi-factorial treatment with conventional care. ADDITION-Leicester consists of community-based screening and intervention phases within 20 general practices coordinated from a single academic research centre. Screening adopts a universal diagnostic approach via repeated 75g-Oral Glucose Tolerance Tests within an eligible non-diabetic population of 66,320 individuals aged 40-75 years (25-75 years South Asian). Volunteers also provide detailed medical and family histories; complete health questionnaires, undergo anthropometric measures, lipid profiling and a proteinuria assessment. Primary outcome is reduction in modelled Coronary Heart Disease (UKPDS CHD) risk at five years. Seven thousand (30% of South Asian ethnic origin) volunteers over three years will be recruited to identify a screen-detected T2DM cohort (n = 285) powered to detected a 6% relative difference (80% power, alpha 0.05) between treatment groups at one year. Randomisation will occur at practice-level with newly diagnosed T2DM cases receiving either conventional (according to current national guidelines) or intensive (algorithmic target-driven multi-factorial cardiovascular risk intervention) treatments. ADDITION-Leicester is the largest multiethnic (targeting >30% South Asian recruitment) community T2DM and vascular risk screening programme in the UK. By assessing feasibility and efficacy of T2DM screening, it will inform national disease prevention policy and contribute significantly to our understanding of the health care needs of UK South Asians. Clinicaltrial.gov (NCT00318032).

/pdf/rationale-and-design-of-the-addition-leicester-study-a-827gdcla9o.pdf

Rationale and design of the ADDITION-Leicester study, a systematic screening programme and Randomised Controlled Trial of multi-factorial cardiovascular risk intervention in people with Type 2 Diabetes Mellitus detected by screening

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Rationale and design of the ADDITION-Leicester study, a systematic screening programme and Randomised Controlled Trial of multi-factorial cardiovascular risk intervention in people with Type 2 Diabetes Mellitus detected by screening