Evidence map›Paper›PMID 19366774›Full record

Trial reportJAMA2009

Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: the DIAD study: a randomized controlled trial.

Lawrence H Young, Frans J Th Wackers, Deborah A Chyun, Janice A Davey, Eugene J Barrett, Raymond Taillefer, Gary V Heller, Ami E Iskandrian, Steven D Wittlin, Neil Filipchuk and 3 more

2 registry-linked trialsOpen access · greenAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in JAMA, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 296 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
296citing papers in PubMed, 10 pooled it
57.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00769275 completednot on this map

Detection of Ischemia in Asymptomatic Diabetics

TypeobservationalSponsorYale UniversityRan2000 to 2008Enrolled1,123ConditionsType 2 Diabetes Mellitus
NCT04388280 naunknown statusnot on this mapstarted 2021, after this paper: background citation

Functional and Anatomic Imaging Versus No Testing in Asymptomatic High-risk Diabetic Patients

TypeinterventionalSponsorClinical Centre of SerbiaRan2021 to 2023Enrolled400ConditionsAsymptomatic, High Risk, DiabetesArmsEchocardiography, CT angiography
3 · Its place in the literature

Who cites it

296 citing papers in PubMed, 10 syntheses or guidelines pooled it, 812 citations in OpenAlex.

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  10. Prognostic value of normal stress myocardial perfusion imaging in diabetic patients: a meta-analysis.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2014
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  12. Prognostic value of SPECT myocardial perfusion entropy in high-risk type 2 diabetic patients.European journal of nuclear medicine and molecular imaging · 2021
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236 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors at 8 institutions in 3 countries.

Lawrence H YoungYale University School of Medicine, Section of Cardiovascular Medicine, Department of Internal Medicine, New Haven, CT 06520, USA.
Frans J Th Wackers
Deborah A Chyun
Janice A Davey
Eugene J Barrett
Raymond Taillefer
Gary V Heller
Ami E Iskandrian
Steven D Wittlin
Neil Filipchuk
Robert E Ratner
Silvio E Inzucchi
DIAD Investigators
Yale University · USCentre for Nursing Innovation · GBInstitute for Community Living · USMedStar Union Memorial Hospital · USUniversité de Montréal · CAUniversity of Alabama at Birmingham · USUniversity of Rochester · USUniversity of Virginia · US

Funding

ZACOPRIDE VS METOCLOPRAMIDE--EFFECT ON LOWER ESOPHAGEAL SPHINCTERM01RR000847 · NCRR · UNIVERSITY OF VIRGINIA CHARLOTTESVILLE · PI HEWLETT, ERIK L · 1985 to 2010
$48.1M
ZIPRASIDONE IN TOURETTES SYNDROME, OBSESSIVE COMPULSIVE &PERVASIVE DEV. DISORDERM01RR000125 · NCRR · YALE UNIVERSITY · PI ALPERN, ROBERT J · 1985 to 2006
$24.1M
ZENARESTAT IN DIABETIC NEUROPATHYM01RR005096 · NCRR · TULANE UNIVERSITY OF LOUISIANA · PI GILBERT, JILL · 1990 to 2006
$17.4M
NCRR NIH HHS 5M01-RR-00847NCRR NIH HHS 6M01-RR-05096NCRR NIH HHS M01 RR000125NCRR NIH HHS M01 RR000847NCRR NIH HHS M01-RR-00125NCRR NIH HHS M01 RR005096
6 · The paper itself

Abstract

contextCoronary artery disease (CAD) is the major cause of mortality and morbidity in patients with type 2 diabetes. But the utility of screening patients with type 2 diabetes for asymptomatic CAD is controversial.

objectiveTo assess whether routine screening for CAD identifies patients with type 2 diabetes as being at high cardiac risk and whether it affects their cardiac outcomes. DESIGN, SETTING, AND PATIENTS: The Detection of Ischemia in Asymptomatic Diabetics (DIAD) study is a randomized controlled trial in which 1123 participants with type 2 diabetes and no symptoms of CAD were randomly assigned to be screened with adenosine-stress radionuclide myocardial perfusion imaging (MPI) or not to be screened. Participants were recruited from diabetes clinics and practices and prospectively followed up from August 2000 to September 2007.

main outcome measureCardiac death or nonfatal myocardial infarction (MI).

resultsThe cumulative cardiac event rate was 2.9% over a mean (SD) follow-up of 4.8 (0.9) years for an average of 0.6% per year. Seven nonfatal MIs and 8 cardiac deaths (2.7%) occurred among the screened group and 10 nonfatal MIs and 7 cardiac deaths (3.0%) among the not-screened group (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.44-1.88; P = .73). Of those in the screened group, 409 participants with normal results and 50 with small MPI defects had lower event rates than the 33 with moderate or large MPI defects; 0.4% per year vs 2.4% per year (HR, 6.3; 95% CI, 1.9-20.1; P = .001). Nevertheless, the positive predictive value of having moderate or large MPI defects was only 12%. The overall rate of coronary revascularization was low in both groups: 31 (5.5%) in the screened group and 44 (7.8%) in the unscreened group (HR, 0.71; 95% CI, 0.45-1.1; P = .14). During the course of study there was a significant and equivalent increase in primary medical prevention in both groups.

conclusionIn this contemporary study population of patients with diabetes, the cardiac event rates were low and were not significantly reduced by MPI screening for myocardial ischemia over 4.8 years.

trial registrationclinicaltrials.gov Identifier: NCT00769275.

Indexed as

Myocardial Perfusion ImagingAdenosineCoronary Artery DiseaseDiabetes Mellitus, Type 2Diabetic AngiopathiesExercise TestFemaleHumansMaleMiddle AgedMyocardial InfarctionRadiopharmaceuticalsTechnetium Tc 99m SestamibiVasodilator AgentsAdenosineRadiopharmaceuticalsTechnetium Tc 99m SestamibiVasodilator Agents

Identifiers

PMID19366774
PMCPMC2895332
OpenAlexW1996082994

What OpenQuestion holds

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LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.