- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01794143
A Comparative Effectiveness Study of Major Glycemia-lowering Medications for Treatment of Type 2 Diabetes (GRADE)
April 13, 2022 updated by: GRADE Study Group
Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study
The GRADE Study is a pragmatic, unmasked clinical trial that will compare commonly used diabetes medications, when combined with metformin, on glycemia-lowering effectiveness and patient-centered outcomes.
Study Overview
Status
Completed
Study Type
Interventional
Enrollment (Actual)
5047
Phase
- Phase 3
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Alabama
-
Birmingham, Alabama, United States
- University of Alabama-Birmingham
-
-
Arizona
-
Phoenix, Arizona, United States
- Southwestern American Indian Center
-
-
California
-
San Diego, California, United States
- Veterans Medical Research Foundation, San Diego (San Diego VA)
-
-
Colorado
-
Denver, Colorado, United States
- University of Colorado
-
-
Connecticut
-
New Haven, Connecticut, United States
- Yale University School of Medicine
-
-
Florida
-
Miami, Florida, United States
- South Florida VA Foundation (Miami VA)
-
-
Georgia
-
Decatur, Georgia, United States
- Atlanta VA Medical Center
-
Duluth, Georgia, United States
- Kaiser Permanente of Georgia
-
-
Hawaii
-
Honolulu, Hawaii, United States
- Pacific Health Research and Education Institute (VA Pacific Islands)
-
-
Indiana
-
Indianapolis, Indiana, United States
- Indiana University School of Medicine
-
-
Iowa
-
Iowa City, Iowa, United States
- University of Iowa
-
-
Louisiana
-
Baton Rouge, Louisiana, United States
- Pennington Biomedical Research Center
-
-
Maryland
-
Hyattsville, Maryland, United States
- MedStar Health Research Institute
-
-
Massachusetts
-
Boston, Massachusetts, United States
- Massachusetts General Hospital
-
-
Michigan
-
Ann Arbor, Michigan, United States
- University of Michigan
-
-
Minnesota
-
Minneapolis, Minnesota, United States
- University of Minnesota
-
Minneapolis, Minnesota, United States
- International Diabetes Center
-
-
Missouri
-
Saint Louis, Missouri, United States
- Washington University School of Medicine
-
-
Nebraska
-
Omaha, Nebraska, United States
- University of Nebraska
-
-
New Mexico
-
Albuquerque, New Mexico, United States
- University of New Mexico School of Medicine
-
-
New York
-
Bronx, New York, United States
- Albert Einstein College of Medicine
-
Brooklyn, New York, United States
- State University of New York (SUNY)-Downstate Medical Center
-
New York, New York, United States
- Columbia University Naomi Berrie Diabetes Center
-
New York, New York, United States
- Mount Sinai St. Luke's Hospital
-
-
North Carolina
-
Durham, North Carolina, United States
- Duke University Medical Center
-
Durham, North Carolina, United States
- University of North Carolina Diabetes Care Center
-
-
Ohio
-
Cincinnati, Ohio, United States
- University of Cincinnati
-
Cleveland, Ohio, United States
- Case Western Reserve University School of Medicine
-
-
Oregon
-
Portland, Oregon, United States
- Oregon Health and Science University
-
Portland, Oregon, United States
- Kaiser Permanente Northwest
-
-
Tennessee
-
Nashville, Tennessee, United States
- Vanderbilt University Medical Center
-
-
Texas
-
Dallas, Texas, United States
- Baylor Endocrine Center
-
Dallas, Texas, United States
- University of Texas-Southwestern Medical Center
-
Houston, Texas, United States
- Baylor College of Medicine
-
San Antonio, Texas, United States
- University of Texas Health Science Center
-
-
Washington
-
Seattle, Washington, United States
- Seattle Institute for Biomedical and Clinical Research
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
28 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Men or women diagnosed with diabetes at age ≥ 30 years (≥ 20 for American Indians)
- Duration of diagnosed diabetes < 10 years
- HbA1c criteria (at final run-in visit, ~2 weeks prior to randomization): 6.8-8.5%
- Taking a daily dose of ≥ 1000 mg metformin for a minimum of 8 weeks at final run-in
- Willingness to administer daily subcutaneous injections, take a second diabetes drug after randomization, potentially initiate insulin and intensify insulin therapy if study metabolic goals are not met, perform self-monitoring of blood glucose
- Fluent in either English or Spanish
- A negative pregnancy test for all females of childbearing potential (i.e. pre-menopausal, and not surgically sterile)
- Provision of signed and dated informed consent prior to any study procedures
Exclusion Criteria:
- Suspected type 1 diabetes (lean with polyuria, polydipsia, and weight loss with little response to metformin) or "secondary" diabetes due to specific causes (e.g. previously diagnosed monogenic syndromes, pancreatic surgery, pancreatitis)
- Current or previous (within past 6 months) treatment with any diabetes drug/glucose-lowering medication other than metformin (limited use of no longer than seven days is allowed, for example during hospitalization)
- More than 10 years of treatment with metformin at time of randomization screening
- History of intolerance or allergy or other contraindications to any of the proposed study medications
- Resides in the same household with another GRADE study participant
- Current need for any specific glucose-lowering medications solely for other conditions, for example for polycystic ovary syndrome
- Symptomatic hyperglycemia requiring immediate therapy during screening or run-in, in the judgment of the physician
- A life-threatening event within 30 days prior to screening or currently planned major surgery
- Any major cardiovascular event in previous year, including history of myocardial infarction, stroke, or vascular procedure such as coronary artery or peripheral bypass grafting, stent placements (peripheral or coronary) or angioplasty.
- Plans for pregnancy during the course of the study for women of child-bearing potential
- History of or planning bariatric surgery, including banding procedures or surgical gastric and/or intestinal bypass (if banding removed, may be considered eligible after 1 year)
- History of congestive heart failure (NYHA 3 or greater)
- History of pancreatitis
- History of cancer, other than non-melanoma skin cancer, that required therapy in the 5 years prior to randomization
- Personal or family history of MEN-2 or family history of medullary thyroid cancer
- Estimated GFR (eGFR) <30 ml/min/1.73 m2 or end stage renal disease requiring renal replacement therapy
- History of severe liver disease or acute hepatitis or ALT > 3 times upper limit of normal
- Current alcoholism or excessive alcohol intake
- Previous organ transplant
- Treatment with oral or systemic glucocorticoids (other than short-term treatment, for example for poison ivy) or disease likely to require periodic or regular glucocorticoid therapy (inhaled steroids are allowed)
- Treatment with atypical antipsychotics
- History of hemolytic anemia, chronic transfusion requirement, or other condition rendering HbA1c results unreliable as indicator of chronic glucose levels, or hematocrit <35 for males and <33 for females
- Clinically or medically unstable with expected survival <1 year
- Unwillingness to permit sites to contact the PCP to communicate information about the study and the participant's data
- No non-study PCP or inability to identify such a PCP (who will provide non-study care) by the time of final run-in
- Participation in another interventional clinical trial
- Previous randomization in the GRADE study
- In the opinion of the principal investigator (PI), any other factor, including language barrier, likely to limit compliance with the protocol
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Sulfonylurea (glimepiride)
Sulfonylurea
|
Used in accordance with labeling and/or usual practice.
Other Names:
|
Active Comparator: DPP-4 inhibitor
DPP-4 inhibitor (sitagliptin)
|
Used in accordance with labeling and/or usual practice
Other Names:
|
Active Comparator: GLP-1 receptor agonist
GLP-1 receptor agonist (liraglutide)
|
Used in accordance with labeling and/or usual practice.
Other Names:
|
Active Comparator: Insulin (glargine)
Insulin (glargine), Lantus
|
Used in accordance with labeling and/or usual practice.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time to HbA1c>=7%, while receiving metformin and the randomly assigned study medication
Time Frame: Quarterly for 4 to 7 years
|
The primary metabolic outcome is the time to primary failure defined as an HbA1c>=7% (53mmol/mol), subsequently confirmed.
|
Quarterly for 4 to 7 years
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time to HbA1c>7.5%, while receiving metformin and the randomly assigned study medication.
Time Frame: Quarterly for 4 to 7 years
|
The secondary metabolic outcome is time to HbA1c>7.5% (58 mmol/mol), confirmed.
|
Quarterly for 4 to 7 years
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time to HbA1c>7.5%, while receiving study medications and basal insulin
Time Frame: Quarterly for 4 to 7 years
|
The tertially metabolic outcome is the time to a HbA1c>7.5% (58 mmol/mol), confirmed, while receiving metformin, the originally assigned medication and basal insulin.
|
Quarterly for 4 to 7 years
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Study Chair: David M Nathan, MD, Massachusetts General Hospital
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- GRADE Study Research Group, Nathan DM, Lachin JM, Bebu I, Burch HB, Buse JB, Cherrington AL, Fortmann SP, Green JB, Kahn SE, Kirkman MS, Krause-Steinrauf H, Larkin ME, Phillips LS, Pop-Busui R, Steffes M, Tiktin M, Tripputi M, Wexler DJ, Younes N. Glycemia Reduction in Type 2 Diabetes - Microvascular and Cardiovascular Outcomes. N Engl J Med. 2022 Sep 22;387(12):1075-1088. doi: 10.1056/NEJMoa2200436.
- GRADE Study Research Group, Nathan DM, Lachin JM, Balasubramanyam A, Burch HB, Buse JB, Butera NM, Cohen RM, Crandall JP, Kahn SE, Krause-Steinrauf H, Larkin ME, Rasouli N, Tiktin M, Wexler DJ, Younes N. Glycemia Reduction in Type 2 Diabetes - Glycemic Outcomes. N Engl J Med. 2022 Sep 22;387(12):1063-1074. doi: 10.1056/NEJMoa2200433.
- Barzilay JI, Ghosh A, Busui RP, Ahmann A, Balasubramanyam A, Banerji MA, Cohen RM, Green J, Ismail-Beigi F, Martin CL, Seaquist E, Luchsinger JA; GRADE Research Group. The cross-sectional association of cognition with diabetic peripheral and autonomic neuropathy-The GRADE study. J Diabetes Complications. 2021 Dec;35(12):108047. doi: 10.1016/j.jdiacomp.2021.108047. Epub 2021 Sep 15.
- Utzschneider KM, Younes N, Rasouli N, Barzilay JI, Banerji MA, Cohen RM, Gonzalez EV, Ismail-Beigi F, Mather KJ, Raskin P, Wexler DJ, Lachin JM, Kahn SE; GRADE Research Group. Shape of the OGTT glucose response curve: relationship with beta-cell function and differences by sex, race, and BMI in adults with early type 2 diabetes treated with metformin. BMJ Open Diabetes Res Care. 2021 Sep;9(1):e002264. doi: 10.1136/bmjdrc-2021-002264.
- Luchsinger JA, Younes N, Manly JJ, Barzilay J, Valencia W, Larkin ME, Falck-Ytter C, Krause-Steinrauf H, Pop-Busui R, Florez H, Seaquist E; GRADE Research Group; GRADE Research Group Investigators:. Association of Glycemia, Lipids, and Blood Pressure With Cognitive Performance in People With Type 2 Diabetes in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). Diabetes Care. 2021 Oct;44(10):2286-2292. doi: 10.2337/dc20-2858. Epub 2021 Jul 20.
- Cherrington AL, Krause-Steinrauf H, Bebu I, Naik AD, Walker E, Golden SH, Gonzalez JS; GRADE Research Group. Study of emotional distress in a comparative effectiveness trial of diabetes treatments: Rationale and design. Contemp Clin Trials. 2021 Aug;107:106366. doi: 10.1016/j.cct.2021.106366. Epub 2021 Mar 22.
- Utzschneider KM, Younes N, Rasouli N, Barzilay J, Banerji MA, Cohen RM, Gonzalez EV, Mather KJ, Ismail-Beigi F, Raskin P, Wexler DJ, Lachin JM, Kahn SE; GRADE Research Group. Association of glycemia with insulin sensitivity and beta-cell function in adults with early type 2 diabetes on metformin alone. J Diabetes Complications. 2021 May;35(5):107912. doi: 10.1016/j.jdiacomp.2021.107912. Epub 2021 Mar 17.
- Rasouli N, Younes N, Utzschneider KM, Inzucchi SE, Balasubramanyam A, Cherrington AL, Ismail-Beigi F, Cohen RM, Olson DE, DeFronzo RA, Herman WH, Lachin JM, Kahn SE; GRADE Research Group. Association of Baseline Characteristics With Insulin Sensitivity and beta-Cell Function in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE) Study Cohort. Diabetes Care. 2021 Feb;44(2):340-349. doi: 10.2337/dc20-1787. Epub 2020 Dec 17.
- Sivitz WI, Phillips LS, Wexler DJ, Fortmann SP, Camp AW, Tiktin M, Perez M, Craig J, Hollander PA, Cherrington A, Aroda VR, Tan MH, Krakoff J, Rasouli N, Butera NM, Younes N; GRADE Research Group. Optimization of Metformin in the GRADE Cohort: Effect on Glycemia and Body Weight. Diabetes Care. 2020 May;43(5):940-947. doi: 10.2337/dc19-1769. Epub 2020 Mar 5.
- Wexler DJ, Krause-Steinrauf H, Crandall JP, Florez HJ, Hox SH, Kuhn A, Sood A, Underkofler C, Aroda VR; GRADE Research Group. Baseline Characteristics of Randomized Participants in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). Diabetes Care. 2019 Nov;42(11):2098-2107. doi: 10.2337/dc19-0901. Epub 2019 Aug 7.
- Behringer-Massera S, Browne T, George G, Duran S, Cherrington A, McKee MD; GRADE Research Group. Facilitators and barriers to successful recruitment into a large comparative effectiveness trial: a qualitative study. J Comp Eff Res. 2019 Jul;8(10):815-826. doi: 10.2217/cer-2019-0010. Epub 2019 Aug 1.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start
May 1, 2013
Primary Completion (Actual)
April 30, 2021
Study Registration Dates
First Submitted
February 13, 2013
First Submitted That Met QC Criteria
February 14, 2013
First Posted (Estimate)
February 18, 2013
Study Record Updates
Last Update Posted (Actual)
April 14, 2022
Last Update Submitted That Met QC Criteria
April 13, 2022
Last Verified
April 1, 2022
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Glucose Metabolism Disorders
- Metabolic Diseases
- Endocrine System Diseases
- Diabetes Mellitus
- Diabetes Mellitus, Type 2
- Hypoglycemic Agents
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Anti-Arrhythmia Agents
- Enzyme Inhibitors
- Immunosuppressive Agents
- Immunologic Factors
- Hormones
- Hormones, Hormone Substitutes, and Hormone Antagonists
- Protease Inhibitors
- Incretins
- Liraglutide
- Sitagliptin Phosphate
- Glimepiride
- Dipeptidyl-Peptidase IV Inhibitors
Other Study ID Numbers
- GRADE
- 1U01DK098246-01 (U.S. NIH Grant/Contract)
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Type 2 Diabetes
-
Antonio Di MauroCompletedType-2 DiabetesItaly
-
DiaMedica Therapeutics IncCompletedDiabetes Type 2Netherlands
-
RenJi HospitalUnknownType 2 Diabetes.China
-
University of Erlangen-Nürnberg Medical SchoolCompletedType 2-diabetesGermany
-
Chengdu Brilliant Pharmaceutical Co., Ltd.Not yet recruitingType 2 Diabetes Mellitus
-
Nanjing First Hospital, Nanjing Medical UniversityRecruitingType 2 Diabetes MellitusChina
-
Xiangya Hospital of Central South UniversityRecruitingType 2 Diabetes MellitusChina
-
University of Alabama at BirminghamCompletedType 2 Diabetes MellitusUnited States
-
Imperial College LondonAstraZeneca; Huma; North West London Collaboration of CCGs (NWL CCGs); Imperial...CompletedType 2 Diabetes MellitusUnited Kingdom
-
Universiti Sains MalaysiaCompleted
Clinical Trials on Sulfonylurea (glimepiride)
-
Mitsubishi Tanabe Pharma CorporationCompletedType 2 Diabetes MellitusJapan
-
Royal Devon and Exeter NHS Foundation TrustWellcome Trust; Haukeland University Hospital; Hôpital Necker-Enfants MaladesCompletedDiabetes Mellitus
-
Dong-A ST Co., Ltd.CompletedType2 DiabetesKorea, Republic of
-
GlaxoSmithKlineCompletedDiabetes Mellitus, Type 2Korea, Republic of, Malaysia, Philippines, Thailand, Russian Federation, Mexico
-
Royal Devon and Exeter NHS Foundation TrustUniversity of Chicago; University of Bergen; University of Rome Tor VergataRecruitingEpilepsy | Intellectual Disability | ADHD | Neurodevelopmental Disorders | Autism Spectrum Disorder | Development DelayUnited States, United Kingdom, Italy, Norway
-
Merck Sharp & Dohme LLCCompleted
-
CinnagenUnknownDiabetes Mellitus, Type 2
-
Mitsubishi Tanabe Pharma CorporationCompletedType 2 Diabetes MellitusJapan
-
University Hospital, Gentofte, CopenhagenCompleted