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DIAD: Outcome not affected by routine screening for CAD in patients with diabetes
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Screening patients with type 2 diabetes for inducible ischemia did not identify patients who were at relatively greater risk than others, according to results of the DIAD study.
Researchers for the Detection of Ischemia in Asymptomatic Diabetes (DIAD) study enrolled 1,123 patients with type 2 diabetes and no symptoms of coronary artery disease. Patients were randomly assigned to adenosine stress radionuclide myocardial perfusion imaging, MPI, (n=561) or no stress testing (n=562) and prospectively followed for a mean of 4.8 years.
The findings were presented at a press briefing held by the Journal of the American Medical Association in Washington, D.C. and were published simultaneously in JAMA.
The researchers reported a cumulative cardiac event rate of 2.9% (32 events) in the patient population. Cardiac death occurred in 15 (1.4%) patients, and 17 (1.5%) patients developed nonfatal MI during follow-up.
There was no difference in cumulative incidence of cardiac events (3.0% vs. 2.7%) between patients screened for CAD vs. those who were not screened. There were eight (1.4%) cardiac deaths in the group who were screened vs. seven (1.2%) in the group not screened, and seven (1.3%) nonfatal MIs in the screened group vs. 10 (1.7%) in the group not screened.
The use of medications such as statins, ACE inhibitors, aspirin and other evidence-based therapies was better in this population than in the general population of patients with type 2 diabetes. “Medication use increased significantly during the course of study but did so comparably in the two groups,” researchers reported in JAMA.
“In patients who have no known CAD, routine screening for CAD is not recommended,” Frans J. Th. Wackers, MD, PhD, professor emeritus of medicine and diagnostic radiology at Yale University School of Medicine, said during the press briefing.
“The yield of screening and the event rates in these patients are very low. The screening will have no effect on the overall outcome, and the routine screening for the 20 million or so patients with diabetes would be prohibitively expensive,” Wackers said. – by Eric Raible
For more information:
- Young L. JAMA. 2009;301:1547-1555.
- Wackers FJT. Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes. Presented at: JAMA News Briefing; April 14, 2009; Washington D.C.