The effect of training GPs in motivational interviewing on incident cardiovascular disease and mortality in people with screen-detected diabetes. Results from the ADDITION-Denmark randomised trial

Morten Charles; Niels Henrik Bruun; Rebecca Simmons; Else-Marie Dalsgaard; Daniel Witte; Marit Jorgensen; Bo Christensen; Helle Terkildsen Maindal; Sune Rubak; Annelli Sandbaek; Torsten Lauritzen

doi:10.3399/bjgpopen20X101012

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Figure 1. Practice and participant flow in the ADDITION-Denmark trial.
^aOwing to restricted resources, a second round of 26 practices were randomised to opportunistic screening plus routine care or opportunistic screening plus intensive multifactorial.
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Figure 2. Cumulative incidence of (A) all-cause mortality and (B) incident cardiovascular disease (CVD) among individuals with normal glucose tolerance in the ADDITION-Denmark routine care (RC), intensive treatment (IT) and intensive treatment plus motivational interviewing groups (IT-MI) (2001–2011). This figure is unadjusted.

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Table 1. Characteristics of individuals with screen-detected diabetes (n = 1615) and non-diabetic hyperglycaemia (n = 2655) in the ADDITION-Denmark study, by treatment group

	Screen-detected diabetes	Non-diabetic hyperglycaemia
RC( n = 669)	IT( n = 524)	IT +MI( n = 422)	RC( n = 1193)	IT( n = 863)	IT +MI( n = 599)
Male sex, n (%)	372 (55.6)	302 (57.6)	244 (57.8)	581 (48.7)	438 (50.8)	309 (51.6)
Mean age ( SD )	59.9 (6.8)	59.4 (7.1)	59.8 (7.0)	59.8 (6.9)	60.3 (6.4)	60.5 (6.6)
Education level, n (%)
0–10 years	246 (37.5)	203 (39.6)	151 (36.4)	475 (40.7)	331 (39.2)	199 (34.1)
10–15 years	288 (43.9)	214 (41.8)	182 (43.9)	464 (39.8)	350 (41.5)	242 (41.4)
> 15 years	122 (18.6)	95 (18.6)	82 (19.8)	227 (19.5)	163 (19.3)	143 (24.5)
Previous CVD, n (%)	36 (5.4)	51 (9.7)	30 (7.1)	91 (7.6)	57 (6.6)	36 (6.0)
Redeemed anti hypertensive medication, n (%)
Year 2000	242 (36.2)	188 (35.9)	157 (37.2)	369 (30.9)	258 (29.9)	208 (34.7)
Year 2005	436 (66.6)	351 (68.7)	325 (79.7)	613 (52.3)	404 (47.9)	309 (53.4)
Year 2010	503 (82.7)	415 (85.9)	333 (89.8)	733 (66.3)	518 (65.9)	398 (72.2)
Redeemed glucose-lowering medication, n (%)
Year 2000	^a	^a	0 (0.0)	0 (0.0)	0 (0.0)	^a
Year 2005	173 (26.4)	177 (34.6)	181 (44.4)	27 (2.3)	23 (2.7)	22 (3.8)
Year 2010	354 (58.2)	315 (65.2)	260 (70.1)	161 (14.6)	111 (14.1)	79 (14.3)
Redeemed lipid-lowering medication, n (%)
Year 2000	45 (6.7)	37 (7.1)	21 (5.0)	58 (4.9)	45 (5.2)	32 (5.3)
Year 2005	319 (48.7)	320 (62.6)	282 (69.1)	282 (24.0)	203 (24.1)	148 (25.6)
Year 2010	454 (74.7)	406 (84.1)	309 (83.3)	495 (44.8)	360 (45.8)	273 (49.5)
CVD events during follow-up, n (%)	116 (17.3)	98 (18.7)	93 (22.0)	221 (18.5)	143 (16.6)	120 (20.0)
Deaths during follow-up, n (%)	93 (13.9)	62 (11.8)	64 (15.2)	126 (10.6)	107 (12.4)	65 (10.9)
HR for CVD ( 95% CI )	–	1.11 (0.82 to 1.50)	1.26 (0.96 to 1.64)	–	0.92 (0.74 to 1.14)	1.00 (0.80 to 1.26)
HR for all-cause mortality ( 95% CI )	–	0.88 (0.61 to 1.27)	1.02 (0.74 to 1.39)l	–	1.23 (0.95 to 1.60)	0.88 (0.65 to 1.19)

CI = confidence intervals. CVD =cardiovascular disease. HR = hazard ratio. IT = intensive treatment. MI = motivational interviewing. RC = routine care. SD = standard deviation.
↵ ^aNumbers too small to report (Denmark Statistics regulations).
Some percentages may not add up to expected total due to reducing cohort size over time and a small amount of missing data for some variables.

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Table 2. Characteristics of individuals with normoglycaemia following screening in the ADDITION-Denmark study (n = 21 451), by treatment group

	NGT	NGT and Heart Score ≥0 to <5	NGT and Heart Score ≥5 to <10	NGT and Heart Score ≥10
RC( n = 10 288)	IT( n = 6616)	IT +MI( n = 4607)	RC( n = 5042)	IT( n = 3062)	IT +MI( n = 2409)	RC( n = 2422)	IT( n = 1447)	IT +MI( n = 1163)	RC( n = 1670)	IT( n = 970)	IT +MI( n = 823)
Male sex, n (%)	5250 (51.0)	3349 (50.6)	2399 (52.1)	1766 (35.0)	996 (32.5)	860 (35.7)	1610 (66.5)	966 (66.8)	759 (65.3)	1373 (82.2)	818 (84.3)	675 (82.0)
Mean age ( SD )	59.1 (6.9)	59.0 (7.0)	59.4 (6.9)	56.0 (6.4)	56.0 (6.3)	55.8 (6.5)	62.3 (5.1)	62.4 (4.9)	62.4 (4.9)	65.1 (4.1)	65.1 (4.2)	65.2 (4.2)
Education, n (%)
0–10 years	3191 (31.5)	2135 (32.7)	1473 (32.4)	1483 (29.8)	925 (30.5)	726 (30.5)	824 (34.5)	491 (34.3)	374 (32.7)	592 (36.2)	334 (35.1)	307 (37.9)
10–15 years	4296 (42.4)	2723 (41.7)	1832 (40.3)	2159 (43.4)	1267 (41.8)	969 (40.7)	983 (41.1)	581 (40.6)	455 (39.8)	672 (41.1)	401 (42.2)	340 (42.0)
>15 years	2640 (26.1)	1671 (25.6)	1236 (27.2)	1332 (26.8)	837 (27.6)	688 (28.9)	582 (24.4)	360 (25.1)	313 (27.4)	372 (22.7)	216 (22.7)	163 (20.1)
Previous CVD, n (%)	470 (4.6)	319 (4.8)	176 (3.8)	194 (3.8)	109 (3.6)	80 (3.3)	130 (5.4)	86 (5.9)	47 (4.0)	80 (4.8)	49 (5.1)	42 (5.1)
Redeemed anti hypertensive medication, n (%)
Year 2000	2429 (23.6)	1551 (23.4)	1112 (24.1)	1180 (23.4)	727 (23.7)	543 (22.5)	606 (25.0)	362 (25.0)	300 (25.8)	405 (24.3)	223 (23.0)	217 (26.4)
Year 2005	4161 (41.0)	2599 (39.7)	1827 (40.4)	1853 (37.1)	1107 (36.4)	825 (34.6)	1036 (43.5)	602 (42.1)	501 (43.9)	837 (51.8)	473 (50.3)	422 (53.6)
Year 2010	5322 (54.9)	3416 (54.7)	2348 (54.4)	2379 (48.8)	1454 (49.3)	1101 (47.5)	1316 (58.8)	791 (58.4)	634 (58.5)	1052 (71.8)	592 (69.6)	508 (71.1)
Redeemed glucose-lowering medication, n (%)
Year 2000	^a	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	^a	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
Year 2005	23 (0.2)	14 (0.2)	9 (0.2)	11 (0.2)	8 (0.3)	6 (0.3)	^a	^a	^a	7 (0.4)	^a	^a
Year 2010	160 (1.7)	110 (1.8)	79 (1.8)	78 (1.6)	49 (1.7)	41 (1.8)	33 (1.5)	24 (1.8)	20 (1.8)	40 (2.7)	19 (2.2)	13 (1.8)
Redeemed lipid-lowering medication, n (%)
Year 2000	383 (3.7)	232 (3.5)	142 (3.1)	162 (3.2)	98 (3.2)	60 (2.5)	111 (4.6)	70 (4.8)	40 (3.4)	76 (4.6)	44 (4.5)	35 (4.3)
Year 2005	1582 (15.6)	987 (15.1)	714 (15.8)	620 (12.4)	376 (12.4)	268 (11.3)	435 (18.3)	275 (19.2)	200 (17.5)	376 (23.3)	206 (21.9)	210 (26.7)
Year 2010	3057 (31.5)	1913 (30.6)	1354 (31.4)	1250 (25.6)	747 (25.3)	579 (25.0)	786 (35.1)	481 (35.5)	370 (34.2)	664 (45.3)	386 (45.4)	334 (46.8)
CVD events during follow-up, n (%)	1665 (16.22)	983 (14.9)	690 (15.0)	617 (12.2)	342 (11.2)	248 (10.3)	430 (17.8)	277 (19.1)	206 (17.7)	460 (27.5)	225 (23.2)	202 (24.5)
Deaths during follow-up, n (%)	825 (8.0)	527 (8.0)	396 (8.6)	235 (4.7)	155 (5.1)	118 (4.9)	244 (10.1)	134 (9.3)	114 (9.8)	281 (16.8)	165 (17.0)	144 (17.5)
HR for CVD ( 95% CI )	–	0.94(0.86 to 1.03)	0.87(0.79 to 0.96)	–	0.92 (0.80 to 1.06)	0.81 (0.69 to 0.94)	–	1.10 (0.93 to 1.30)	0.95 (0.78 to 1.17)	–	0.84 (0.72 to 0.97)	0.85 (0.74 to 0.99)
HR for all-cause mortality ( 95% CI )	–	1.05(0.92 to 1.19)	0.98(0.86 to 1.12)	–	1.12 (0.89 to 1.40)	1.00 (0.81 to 1.23)	–	0.94 (0.78 to 1.14)	0.90 (0.76 to 1.07)	–	1.05 (0.86 to 1.27)	1.01 (0.79 to 1.28)

CVD = cardiovascular disease. HR = hazard ratio. IT = intensive treatment. MI = motivational interviewing. NGT = normal glucose tolerance. SD = standard deviation.
^aNumbers too small to report (Denmark Statistics regulations).
Some percentages may not add up to expected total due to reducing cohort size over time and a small amount of missing data for some variables