Original research| Volume 8, ISSUE 4, P322-329, December 2014

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Socioeconomic position and cardiovascular risk factors among people with screen-detected Type 2 DM: Six-year follow-up of the ADDITION-Denmark trial

Published:March 10, 2014DOI:



      To examine whether socioeconomic position (SEP) was associated with change in cardiovascular risk factors and meeting treatment targets for cardiovascular risk factors among individuals with screen-detected Type 2 DM at six-year follow-up.


      The study population was 1533 people with Type 2 DM identified from at stepwise diabetes screening programme in general practice during 2001–2006 in the ADDITION-Denmark study. The ADDITION-study was performed as a randomised trial but the two randomisation groups were analysed as one cohort in this study. Cardiovascular risk factors were measured at baseline and repeated at follow-up (mean: 5.9 [1.4] years). Information on SEP, redeemed antihypertensive and lipid-lowering treatment were obtained from Danish registers. Multivariate analyses were performed to estimate change in cardiovascular risk factors and difference in meeting treatment targets.


      The change in HbA1c, cholesterol, blood pressure and BMI were virtually the same across educational level, income level, occupational status or cohabiting status. Overall, the ability to meet treatment targets for HbA1c, cholesterol and blood pressure was not modified by SEP-group. A higher proportion of people with lower educational level or lower income level in the intensive care redeemed anti-hypertensive treatment compared to people with higher educational or income levels.


      Screen-detection and early treatment onset did not introduce socioeconomic inequality in metabolic control in people with screen-detected Type 2 DM at six-year follow-up.


      ADDITION (Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care), SEP (socioeconomic position)


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        • Gaede P.
        • Lund-Andersen H.
        • Parving H.H.
        • Pedersen O.
        Effect of a multifactorial intervention on mortality in Type 2 diabetes.
        N. Engl. J. Med. 2008; 35: 580-591
        • Bachmann M.O.
        • Eachus J.
        • Hopper C.D.
        • et al.
        Socio-economic inequalities in diabetes complications, control, attitudes and health service use: a cross-sectional study.
        Diabet. Med. 2003; 20: 921-929
        • Bihan H.
        • Laurent S.
        • Sass C.
        • et al.
        Association among individual deprivation, glycemic control, and diabetes complications: the EPICES score.
        Diabetes Care. 2005; 28: 2680-2685
        • Larranaga I.
        • Arteagoitia J.M.
        • Rodriguez J.L.
        • et al.
        Socio-economic inequalities in the prevalence of Type 2 diabetes, cardiovascular risk factors and chronic diabetic complications in the Basque Country, Spain.
        Diabet. Med. 2005; 22: 1047-1053
        • Reisig V.
        • Reitmeir P.
        • Doring A.
        • et al.
        • KORA Study Group
        Social inequalities and outcomes in Type 2 diabetes in the German region of Augsburg. A cross-sectional survey.
        Int. J. Public Health. 2007; 52: 158-165
        • Wild S.
        • Macleod F.
        • McKnight J.
        • et al.
        Impact of deprivation on cardiovascular risk factors in people with diabetes: an observational study.
        Diabet. Med. 2008; 25: 194-199
        • Jackson C.A.
        • Jones N.R.
        • Walker J.J.
        • et al.
        Area-based socioeconomic status, Type 2 diabetes and cardiovascular mortality in Scotland.
        Diabetologia. 2012; 55: 2938-2945
        • Gnavi R.
        • Canova C.
        • Picariello R.
        • et al.
        Mortality, incidence of cardiovascular diseases, and educational level among the diabetic and non-diabetic populations in two large Italian cities.
        Diabetes Res. Clin. Pract. 2011; 92: 205-212
        • Forssas E.H.
        • Keskimaki I.T.
        • Reunanen A.R.
        • Koskinen S.V.
        Coronary heart disease among diabetic and nondiabetic people – socioeconomic differences in incidence, prognosis and mortality.
        J. Diabetes Complicat. 2008; 22: 10-17
        • O’Kane M.J.
        • McMenamin M.
        • Bunting B.P.
        • et al.
        The relationship between socioeconomic deprivation and metabolic/cardiovascular risk factors in a cohort of patients with Type 2 diabetes mellitus.
        Prim. Care Diabetes. 2010; 4: 241-249
        • Edwards R.
        • Burns J.A.
        • McElduff P.
        • et al.
        Variations in process and outcomes of diabetes care by socio-economic status in Salford, UK.
        Diabetologia. 2003; 46: 750-759
        • James G.D.
        • Baker P.
        • Badrick E.
        • et al.
        Ethnic and social disparity in glycaemic control in Type 2 diabetes; cohort study in general practice 2004–9.
        J. R. Soc. Med. 2012; 105: 300-308
        • Lauritzen T.
        • Griffin S.
        • Borch-Johnsen K.
        • et al.
        The ADDITION study: proposed trial of the cost-effectiveness of an intensive multifactorial intervention on morbidity and mortality among people with Type 2 diabetes detected by screening.
        Int. J. Obes. Relat. Metab. Disord. 2000; 24: 6-11
        • Griffin S.J.
        • Borch-Johnsen K.
        • Davies M.J.
        • et al.
        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.
        Lancet. 2011; 378: 156-167
        • Christensen J.O.
        • Sandbaek A.
        • Lauritzen T.
        • Borch-Johnsen K.
        Population-based stepwise screening for unrecognised Type 2 diabetes is ineffective in general practice despite reliable algorithms.
        Diabetologia. 2004; 47: 1566-1573
        • Glumer C.
        • Carstensen B.
        • Sandbaek A.
        • et al.
        A Danish diabetes risk score for targeted screening: the Inter99 study.
        Diabetes Care. 2004; 27: 727-733
        • Alberti K.G.
        • Zimmet P.Z.
        Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation.
        Diabet. Med. 1998; 15: 539-553
      1. Statistics Denmark, Available from (accessed 13.02.13).

        • Galobardes B.
        • Lynch J.
        • Smith G.D.
        Measuring socioeconomic position in health research.
        Br. Med. Bull. 2001; 81/82: 21-37
      2. International Standard Classification of Education, Available from (accessed 13.02.13).

      3. What are equivalence scales? Available from http://, 2008 (accessed 13.0213).

        • Pedersen C.B.
        The Danish Civil Registration System.
        Scand. J. Public Health. 2011; 39: 22-25
        • Lynge E.
        • Sandegaard J.L.
        • Rebolj M.
        The Danish National Patient Register.
        Scand. J. Public Health. 2011; 39: 30-33
        • Kildemoes H.W.
        • Sorensen H.T.
        • Hallas J.
        The Danish National Prescription Registry.
        Scand. J. Public Health. 2011; 39: 38-41
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J. Chronic. Dis. 1987; 40: 373-383
        • Sundquist K.
        • Chaikiat A.
        • Leon V.R.
        • et al.
        Country of birth, socioeconomic factors, and risk factor control in patients with Type 2 diabetes: a Swedish study from 25 primary health-care centres.
        Diabetes Metab. Res. Rev. 2011; 27: 244-254
        • Lawlor D.A.
        • Patel R.
        • Fraser A.
        • et al.
        The association of life course socio-economic position with diagnosis, treatment, control and survival of women with diabetes: findings from the British Women's Heart and Health Study.
        Diabet. Med. 2007; 24: 892-900
        • O’Connor R.
        • Houghton F.
        • Saunders J.
        • Dobbs F.
        Diabetes mellitus in Irish general practice: level of care as reflected by HbA1c values.
        Eur. J. Gen. Pract. 2006; 12: 58-65
        • Harris M.I.
        • Klein R.
        • Welborn T.A.
        • Knuiman M.W.
        Onset of NIDDM occurs at least 4–7 yr before clinical diagnosis.
        Diabetes Care. 1992; 15: 815-819
        • Dalsgaard E.M.
        • Lauritzen T.
        • Christiansen T.
        • et al.
        Socioeconomic factors related to attendance at a Type 2 diabetes screening programme.
        Diabet. Med. 2009; 26: 518-525