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

Table 2 ADDITION-Leicester algorithm for the management of hyperglycaemia, hypertension and dyslipidaemia.

	Basic Treatment TARGET	add if above TARGET	add if above TARGET +BMI>19 or creatinine>130	Supplementary treatment If still above TARGET
Blood Glucose	*HbA1c <6.5%* SMBG Tuition DESMOND Dietary Advice	*HbA1c >6.5%* SMBG Tuition DESMOND Biguanide	*HbA1c >6.5%* SMBG Tuition DESMOND Insulin	*HbA1c >6.5%* Biguanide Sulphonylureas Thiazolidinediones THEN Stop TZD Add basal Insulin (bedtime)	*HbA1c >6.5%* *and on* *Biguanide* *Sulphonylureas* *Insulin* (basal/bolus) Intensify & titrate Insulin
Blood Pressure	BP *< 130/80 mmHg* No treatment	BP *>130/80 mmHg* ACE	*BP >135/80 mmHg* ARB CCB Thiazide	BP *>130/80 mmHg* ACE ARB/CCB	Thiazide alpha/beta Blocker
Cholesterol	*<3.5 mmol/L* Diet	> *3.5 mmol/L* *TG >6.0 mmol/L* Diet Statin Consider Ezetimibe/Fibrate
Aspirin	75 mg to all patients, unless contraindications of gastrointestinal bleeding, ulcers or haemophilia. If Aspirin contraindicated, consider Clopidogrel.

KEY
ACE: Perindopril 2-4 mg daily or Ramipril 2.5-10 mg daily
SMBG: self-monitored blood glucose
Biguanide: Metformin 1-2 g daily
Sulphonylurea: Gliclazide MR 30-120 mg daily or Glimepiride 1-4 mg daily
Insulin: Basal analogue: Glargine. Short-acting analogue: Novorapid or Premixed: Novomix30 twice daily
Thiazolidinedione: Pioglitazone 30-45 mg daily
ARB: Angiotensin receptor blocker: Losartan 25-50 mg daily
CCB: Calcium Channel Blocker: Amlodipine 5 mg daily
Thiazide: Bendrofluazide 2.5 mg daily
Alpha/beta blocke r: Doxazosin MR 4-8 mg or Bisoprolol 5-10 mg daily
Statin: Simvastatin 20-40 mg or Atorvastatin 20-40 mg daily
Fibrate: Fenofibrate (micro) 267 mg or Bezafibrate MR 400 mg daily

ISSN: 1745-6215