Association of Baseline Factors With Glycemic Outcomes in GRADE: A Comparative Effectiveness Randomized Clinical
W Timothy Garvey1, Robert M Cohen2, Nicole M Butera3
1Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL.
Diabetes Care
|January 29, 2024
Summary
Younger age and higher baseline HbA1c predict poorer glycemic control in type 2 diabetes, but do not affect medication effectiveness. Identifying these factors can guide more aggressive treatment strategies.
Area of Science:
- Endocrinology and Metabolism
- Clinical Diabetes Research
- Pharmacotherapy
Background:
- Type 2 diabetes management requires effective glucose-lowering strategies.
- Metformin is a common first-line therapy, but additional agents are often needed.
- Understanding factors influencing glycemic control is crucial for personalized treatment.
Purpose of the Study:
- To examine baseline factors associated with glycemic outcomes in type 2 diabetes.
- To investigate if these factors influence the effectiveness of different add-on medications to metformin.
- To identify predictors of achieving and maintaining target HbA1c levels.
Main Methods:
- The Glycemia Reduction Approaches in Diabetes (GRADE) study randomized 5,047 participants with type 2 diabetes to basal insulin (glargine), glimepiride, liraglutide, or sitagliptin.
- Baseline factors were analyzed for association with achieving HbA1c <7.0% at years 1 and 4 using regression and classification and regression tree (CART) analyses.
- Participants had type 2 diabetes diagnosed for <10 years, were on metformin, and had HbA1c 6.8-8.5%.
Main Results:
- Younger age, Hispanic ethnicity, higher baseline HbA1c, fasting glucose, triglycerides, lower insulin secretion, and higher insulin resistance were associated with poorer glycemic outcomes.
- No baseline factors predicted differential effectiveness among glargine, glimepiride, liraglutide, and sitagliptin by year 4.
- Multivariate analysis showed younger age and higher baseline HbA1c and fasting glucose were jointly associated with glycemic outcomes.
- CART analysis identified younger age and baseline HbA1c ≥7.4% as predictors of failing to maintain HbA1c <7% by year 4.
Conclusions:
- Baseline factors significantly impact glycemic control in type 2 diabetes but do not alter the comparative effectiveness of the studied medications.
- Younger age and higher baseline HbA1c are key predictors of glycemic deterioration.
- Identifying patients at risk for poor glycemic control can facilitate targeted, more aggressive management strategies.
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