Prevalence of microvascular and macrovascular disease in the Glycemia Reduction Approaches in Diabetes - A Comparative Effectiveness (GRADE) Study cohort.

Journal Article (Journal Article)

AIMS: The Glycemia Reduction Approaches in Diabetes - A Comparative Effectiveness (GRADE) trial is a randomized clinical trial comparing glycemic effects of four diabetes medications added to metformin in type 2 diabetes (T2D). Microvascular and macrovascular diseases are secondary outcomes. We evaluated the prevalence and risk factor relationships for microvascular and macrovascular complications in the GRADE cohort at study entry. METHODS: Complication prevalence and risk factors were analyzed based on data from screening in all consenting participants meeting GRADE eligibility. Logistic regression and Z-statistics were used to assess risk factor relationships with complications. RESULTS: We enrolled 5047 T2D participants [mean age 57 years; 36% female; mean known T2D duration 4 years (all < 10 years); mean HbA1c 8.0% (∼64 mmol/mol) at screening]. Urinary albumin/creatinine ratio (ACR) ≥ 30 mg/gram was present in 15.9% participants; peripheral neuropathy (by Michigan Neuropathy Screening Instrument) in 21.5%; cardiovascular autonomic neuropathy by electrocardiography-derived indices in 9.7%; self-reported retinopathy in 1.0%. Myocardial infarction ascertained by self-report or electrocardiogram was present in 7.3%, and self-reported history of stroke in 2.0%. CONCLUSIONS: In the GRADE cohort with < 10 years of T2D and a mean HbA1c of 8.0%, diabetes complications were present in a substantial fraction of participants, more so than might otherwise have been expected.

Full Text

Duke Authors

Cited Authors

  • Mather, KJ; Bebu, I; Baker, C; Cohen, RM; Crandall, JP; DeSouza, C; Green, JB; Kirkman, MS; Krause-Steinrauf, H; Larkin, M; Pettus, J; Seaquist, ER; Soliman, EZ; Schroeder, EB; Wexler, DJ; Pop-Busui, R; GRADE Research Group,

Published Date

  • July 2020

Published In

Volume / Issue

  • 165 /

Start / End Page

  • 108235 -

PubMed ID

  • 32450102

Pubmed Central ID

  • PMC7416515

Electronic International Standard Serial Number (EISSN)

  • 1872-8227

Digital Object Identifier (DOI)

  • 10.1016/j.diabres.2020.108235


  • eng

Conference Location

  • Ireland