Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE)
Nationwide clinical trial comparing
common medications for type 2 diabetes
Latest News

The GRADE study was recognized as one of the 2023 Top 10 Clinical Research Achievements by the Clinical Research Forum

Diabetes Care publishes special issue, April 2024 featuring ten new articles with important findings from GRADE

Analysis of cardiovascular outcomes confirm modest superiority of liraglutide among people with T2DM at relatively low cardiovascular risk

We observed no difference in kidney outcomes over 5 years across participants randomized to one of 4 glucose-lowering medications added to metformin

NIDDK Press Release on ​​​​​​​GRADE Main Study Results – Wednesday, September 21, 2022

We measured GAD-65 antibodies in a subgroup of GRADE particpants and found no association with β-cell dysfunction in GRADE

Key Findings

Improved HbA1c

All study medications (insulin glargine, liraglutide, sitagliptin, and glimepiride) when added to metformin lowered HbA1c. After 4 years of follow-up, participants taking liraglutide or insulin glargine added to metformin reached and maintained target blood glucose levels for the longest time.

Side Effects

On average, participants in all treatment groups lost weight. Over 4 years, participants in the liraglutide and sitagliptin groups lost more weight than those assigned to the glargine and glimepiride groups. Overall, severe hypoglycemia was rare. Participants taking liraglutide reported more frequent gastrointestinal side effects and weight loss compared to the other 3 groups.

Subgroup Differences

No differences were seen in participants reaching the primary outcome of HbA1c level of 7.0% or higher, by sex, age, or race or ethnic group for subgroups prespecifed by the study.  ​​​​​​​

Responsive Image
Responsive Image
The GRADE study was supported by NIDDK, NIH, ADA, NHLBI and the CDC. The Department of Veterans Affairs provided resources and facilities. Educational materials were provided by the National Diabetes Education Program. Material support in the form of donated medications and supplies was provided by Beckton, Dickinson and Company, Bristol-Myers Squibb, Merck & Co., Inc., Novo Nordisk, Roche Diagnostics, and Sanofi.
Our Study Participants - Thank you!
The GRADE Study Research Group is deeply grateful to our participants whose loyal dedication made GRADE possible.
Responsive Image
Responsive Image