Metformin, Then What? More Findings From the GRADE Study

This transcript has been edited for clarity.

Hi. I'm Dr Anne Peters. Today, I'm going to give you some updates on the GRADE study.

Just to refresh your memory, the GRADE study was first presented at the American Diabetes Association (ADA) meetings in June, and those were the preliminary results. More of the final results were just presented at the European Association for the Study of Diabetes (EASD) meeting, and in about a month or so, we'll be able to read the final manuscript. The GRADE study was designed to determine the next best therapy to add to metformin when treating an individual with type 2 diabetes.

They took individuals with type 2 diabetes on metformin alone who weren't at target. The average A1c here wasn't all that high, starting out at 7.5%. These individuals were randomized to one of four treatments, including a sulfonylurea agent, which was glimepiride; a dipeptidyl peptidase 4 (DPP-4) inhibitor, sitagliptin; a glycoprotein 1 (GLP-1) receptor agonist, liraglutide; and insulin glargine. They then were followed, and the primary endpoint was how long it took for that combination therapy to fail. The definition of failing was an A1c ≥ 7%.

Then, if the A1c rose to > 7.5%, they were continued on what they were on, and basal