LINK TO RESEARCH
Deborah J Wexler 1 ,
Heidi Krause-Steinrauf 2 ,
Jill P Crandall 3 ,
Hermes J Florez 4 ,
Sophia H Hox 5 ,
Alexander Kuhn 6 ,
Ajay Sood 7 ,
Chantal Underkofler 8 ,
Vanita R Aroda 6 ,
GRADE Research Group
Objective: GRADE (Glycemia Reduction Approaches in Diabetes: A Comparative
Effectiveness Study) is a 36-center unmasked, parallel treatment group,
randomized controlled trial evaluating four diabetes medications added to
metformin in people with type 2 diabetes (T2DM). We report baseline
characteristics and compare GRADE participants to a National Health and
Nutrition Examination Survey (NHANES) cohort.
Research design and methods: Participants were age ≥30 years at the time of diagnosis, with duration of
T2DM <10 years, HbA1c 6.8-8.5% (51-69 mmol/mol), prescribed metformin monotherapy, and randomized to glimepiride, sitagliptin, liraglutide, or insulin glargine. Results: At baseline, GRADE's 5,047 randomized participants were 57.2 ± 10.0 years of age, 63.6% male, with racial/ethnic breakdown of 65.7% white, 19.8% African American, 3.6% Asian, 2.7% Native American, 7.6% other or unknown, and 18.4% Hispanic/Latino. Duration of diabetes was 4.2 ± 2.8 years, with mean HbA1c of 7.5 ± 0.5% (58 ± 5.3 mmol/mol), BMI of 34.3 ± 6.8 kg/m2, and metformin dose of 1,944 ± 204 mg/day. Among the cohort, 67% reported a history of hypertension, 72% a history of hyperlipidemia, and 6.5% a history of heart attack or stroke. Applying GRADE inclusion criteria to NHANES indicates enrollment of a representative cohort with T2DM on metformin monotherapy (NHANES cohort average age, 57.9 years; mean HbA1c, 7.4% [57 mmol/mol]; BMI, 33.2 kg/m2; duration, 4.2 ± 2.5 years; and 7.2% with a history of cardiovascular disease). Conclusions: The GRADE cohort represents patients with T2DM treated with metformin requiring a second diabetes medication. GRADE will inform decisions about the clinical effectiveness of the addition of four classes of diabetes medications to metformin.
Interested in this research and working with us? Please contact us here.