Comparison of the Continuous Glucose Monitoring Profiles of Four Glucose-Lowering Medications in the GRADE Randomized Trial.

Details

• Alternative Title:
  Diabetes Care, 2026, v. 49, no. 6: Comparison of the Continuous Glucose Monitoring Profiles of Four Glucose-Lowering Medications in the GRADE Randomized Trial.
• Journal Article:
  Diabetes Care
• Personal Author:
  Bergenstal, Richard M. ; Crandall, Jill P. ; Rosin, Samuel P. ; Butera, Nicole M. ; Bantle, Anne ; Desouza, Cyrus ; Duran-Valdez, Elizabeth ; Hall, Stephanie ; Herman, William H. ; Johnson, Mary L. ; Lagari, Violet ; Larkin, Mary E. ; Phillips, Lawrence S. ; Willis, Holly J. ; Krause-Steinrauf, Heidi
• Description:
  Glycemic management metrics derived from continuous glucose monitoring (CGM) are increasingly recognized as important therapeutic targets. We performed one of the first comparisons of CGM metrics and achievement of CGM targets among four classes of glucose-lowering medications in combination with metformin.
  
  The Glycemia Reduction Approaches in Diabetes (GRADE) study randomly assigned participants with type 2 diabetes and taking metformin to add one of four glucose-lowering medications (insulin glargine, glimepiride, liraglutide, or sitagliptin) and followed them for glycemic outcomes for 5 ± 1.3 years. A 2-week masked CGM analysis was conducted midstudy in 1,080 participants to evaluate CGM metrics, 24-h ambulatory glucose profile, and achievement of consensus goals. Treatment effects among the four groups were compared.
  
  The sitagliptin and liraglutide groups had the highest time in range 70-180 mg/dL (TIR70-180) and the lowest time below range <70 mg/dL (TBR<70) and percentage coefficient of variation (%CV). The glimepiride group had the lowest TIR70-180, and the highest %CV, TBR<70, and number of CGM-derived hypoglycemic events (P < 0.001), and was the only drug showing daytime hypoglycemia. Sitagliptin and liraglutide were best for achieving consensus goals of very low TBR<54 <1% and the combined metric of TIR70-180 >70% and TBR<70 <4% (P < 0.001). When stratified by HbA1c, mean glucose did not differ among treatments, but %CV and TBR<70 were higher with glargine and glimepiride within each HbA1c stratum.
  
  Incretin class drugs had the lowest %CV, the least hypoglycemia, and best achievement of CGM-based glycemic targets. CGM metrics and profiles provide clinical insights, beyond HbA1c, to guide diabetes management.
• Content Notes:
  Author manuscript
• Subjects:
  • Humans
  • Hypoglycemic Agents
  • Male
  • Female
  • Sulfonylurea Compounds
  • Diabetes Mellitus, Type 2
  • Middle Aged
  • Blood Glucose
  • Sitagliptin Phosphate
  • Liraglutide
  More +
• Keywords:
  • Continuous glucose monitoring (CGM)
  • Hypoglycemia
  • Type 2 Diabetes
  • Time in range
  • Comparative effectiveness
  • Incretin drugs
• Source:
  Diabetes Care, 2026, v. 49, no. 6
• DOI:
  https://doi.org/10.2337/dc25-3055
• ISSN:
  0149-5992 ; 1935-5548
• Pubmed ID:
  41925680
• Pubmed Central ID:
  PMC13186179
• Document Type:
  Text
• Funding:
  HL/NHLBI NIH HHSUnited States/ ; American Diabetes Association/ ; U01DK098246/Division of Diabetes, Endocrinology, and Metabolic Diseases/ ; U01 DK098246/DK/NIDDK NIH HHSUnited States/ ; U34DK088043/Division of Diabetes, Endocrinology, and Metabolic Diseases/ ; CC/CDC HHSUnited States/ ; HL/NHLBI NIH HHSUnited States/ ; CC/CDC HHSUnited States/
• Genre:
  Journal Article
• Pages in Document:
  981-989 (21 pdf pages)
• Volume:
  49
• Issue:
  6
• Download URL:
  https://stacks.cdc.gov/view/cdc/260710/cdc_260710_DS1.pdf
• File Type:
  [PDF - 1.22 MB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:a5f72e0a9ceb8a531212160d0322d667cd133821611c979e854edcb1b9c0e5f49c382a4555a4588b4f8ac193c26a8dede429060eeddc313ab89f1468cb030889