The UNC Diabetes Care Center in Durham, N.C. is looking for volunteers to take part in a study to compare the long-term benefits and risks of four widely used diabetes drugs in combination with metformin, the most common first-line medication for treating type 2 diabetes. Beginning recruitment in June, the project is called the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE) Study.
If metformin is not enough to help manage type 2 diabetes, a person’s doctor may add one of several other drugs to lower glucose (blood sugar). But while short-term studies have shown the efficacy of different drugs when used with metformin, there have been no long-term studies of which combination works best and has fewer side effects.The study will compare drug effects on glucose levels, adverse effects, diabetes complications and quality of life over an average of nearly five years.
“Type 2 diabetes is a progressive disease that requires the addition of more medications over time.”
“Type 2 diabetes is a progressive disease that requires the addition of more medications over time,” said Sue Kirkman, MD, the principal investigator of the study at UNC. “The GRADE study will provide important information to clinicians about the comparative effectiveness of four commonly used drug classes. UNC is honored to be one of 37 sites participating in this multi-center NIH trial. To increase our reach into the community, we will enroll and follow participants both at our Highgate clinical trials office in Durham and at UNC Diabetes Research at Eagles, located in Greensboro.”
GRADE aims to enroll about 5,000 patients. Investigators at UNC and 36 other study sites are seeking people diagnosed with type 2 diabetes within the last five years. They may be on metformin, but not on any other diabetes medication. During the study, all participants will take metformin, along with a second medication randomly assigned from among four classes of medications, all approved for use with metformin by the U.S. Food and Drug Administration.
Three of the classes of medications increase insulin levels. They are: sulfonylurea, which increases insulin levels directly; DPP-4 inhibitor, which indirectly increases insulin levels by increasing the effect of a naturally occurring intestinal hormone; and GLP-1 agonist, which increases the amount of insulin released in response to nutrients. The fourth type of medication is a long-acting insulin.
“What differentiates GRADE from previous studies is that it will perform a head-to-head comprehensive comparison of the most commonly used drugs over a long period of time.”
Participants will have their diabetes medications managed free of charge through the study, including at least four medical visits per year, but will receive other health care through their own providers.
“What differentiates GRADE from previous studies is that it will perform a head-to-head comprehensive comparison of the most commonly used drugs over a long period of time,” said David M. Nathan, MD, of Massachusetts General Hospital, Boston. Nathan and John Lachin, ScD, of The George Washington University, Washington, D.C., are co-principal investigators.
“In addition to determining which medications control blood glucose levels most effectively over time, we hope to examine individual factors that are associated with better or worse response to the different medications,” Nathan said. “This should provide understanding of how to personalize the treatment of diabetes.”
GRADE (ClinicalTrials.gov number: NCT01794143) is supported under NIH grant U01DK098246. Additional support in the form of donation of supplies comes from the National Diabetes Education Program, Sanofi-Aventis, Bristol-Myers Squibb, Novo Nordisk, Merck, BD Medical and Roche Diagnostics.
Learn more about the study at https://grade.bsc.gwu.edu.
For information about enrolling in the trial, contact Michelle Duclos at 919-484-0931 for the UNC Diabetes Care Center in Durham or Dawn Culmer at 919-260-8850 for the UNC Diabetes Research at Eagles in Greensboro.
Visit the UNC Diabetes Care Center website at www.uncdiabetes.org.