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A Comparative Effectiveness Study of Major Glycemia-lowering Medications for Treatment of Type 2 Diabetes (GRADE)

This study is currently recruiting participants.
See Contacts and Locations
Verified June 2017 by GRADE Study Group
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
National Heart, Lung, and Blood Institute (NHLBI)
Becton, Dickinson and Company
Bristol-Myers Squibb
Merck Sharp & Dohme Corp.
Novo Nordisk A/S
Roche Diagnostics
Information provided by (Responsible Party):
GRADE Study Group Identifier:
First received: February 13, 2013
Last updated: June 22, 2017
Last verified: June 2017
The GRADE Study is a pragmatic, unmasked clinical trial that will compare commonly used diabetes medications, when combined with metformin, on glycemia-lowering effectiveness and patient-centered outcomes.

Condition Intervention Phase
Type 2 Diabetes Comparative Effectiveness of Glycemia-lowering Medications Drug: Sulfonylurea (glimepiride) Drug: DPP-4 inhibitor (sitagliptin) Drug: GLP-1 receptor agonist (liraglutide) Drug: Insulin (glargine) Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: No masking
Primary Purpose: Treatment
Official Title: Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study

Resource links provided by NLM:

Further study details as provided by GRADE Study Group:

Primary Outcome Measures:
  • Time to HbA1c>=7%, while receiving metformin and the randomly assigned study medication [ Time Frame: Quarterly for 4 to 7 years ]
    The primary metabolic outcome is the time to primary failure defined as an HbA1c>=7% (53mmol/mol), subsequently confirmed.

Secondary Outcome Measures:
  • Time to HbA1c>7.5%, while receiving metformin and the randomly assigned study medication. [ Time Frame: Quarterly for 4 to 7 years ]
    The secondary metabolic outcome is time to HbA1c>7.5% (58 mmol/mol), confirmed.

Other Outcome Measures:
  • Time to HbA1c>7.5%, while receiving study medications and basal insulin [ Time Frame: Quarterly for 4 to 7 years ]
    The tertially metabolic outcome is the time to a HbA1c>7.5% (58 mmol/mol), confirmed, while receiving metformin, the originally assigned medication and basal insulin.

Estimated Enrollment: 5000
Study Start Date: May 2013
Estimated Primary Completion Date: August 2020 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Sulfonylurea (glimepiride)
Drug: Sulfonylurea (glimepiride)
Used in accordance with labeling and/or usual practice.
Other Name: Glimepiride
Active Comparator: DPP-4 inhibitor
DPP-4 inhibitor (sitagliptin)
Drug: DPP-4 inhibitor (sitagliptin)
Used in accordance with labeling and/or usual practice
Other Name: Sitagliptin
Active Comparator: GLP-1 receptor agonist
GLP-1 receptor agonist (liraglutide)
Drug: GLP-1 receptor agonist (liraglutide)
Used in accordance with labeling and/or usual practice.
Other Name: Liraglutide
Active Comparator: Insulin (glargine)
Insulin (glargine), Lantus
Drug: Insulin (glargine)
Used in accordance with labeling and/or usual practice.
Other Name: Lantus


Ages Eligible for Study:   30 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Men or women diagnosed with diabetes at age ≥ 30 years (≥ 20 for American Indians)
  2. Duration of diagnosed diabetes < 10 years
  3. HbA1c criteria (at final run-in visit, ~2 weeks prior to randomization): 6.8-8.5%
  4. Taking a daily dose of ≥ 1000 mg metformin for a minimum of 8 weeks at final run-in
  5. Willingness to administer daily subcutaneous injections, take a second diabetes drug after randomization, potentially initiate insulin and intensify insulin therapy if study metabolic goals are not met, perform self-monitoring of blood glucose
  6. Fluent in either English or Spanish
  7. A negative pregnancy test for all females of childbearing potential (i.e. pre-menopausal, and not surgically sterile)
  8. Provision of signed and dated informed consent prior to any study procedures

Exclusion Criteria:

  1. Suspected type 1 diabetes (lean with polyuria, polydipsia, and weight loss with little response to metformin) or "secondary" diabetes due to specific causes (e.g. previously diagnosed monogenic syndromes, pancreatic surgery, pancreatitis)
  2. Current or previous (within past 6 months) treatment with any diabetes drug/glucose-lowering medication other than metformin (limited use of no longer than seven days is allowed, for example during hospitalization)
  3. More than 10 years of treatment with metformin at time of randomization screening
  4. History of intolerance or allergy or other contraindications to any of the proposed study medications
  5. Resides in the same household with another GRADE study participant
  6. Current need for any specific glucose-lowering medications solely for other conditions, for example for polycystic ovary syndrome
  7. Symptomatic hyperglycemia requiring immediate therapy during screening or run-in, in the judgment of the physician
  8. A life-threatening event within 30 days prior to screening or currently planned major surgery
  9. Any major cardiovascular event in previous year, including history of myocardial infarction, stroke, or vascular procedure such as coronary artery or peripheral bypass grafting, stent placements (peripheral or coronary) or angioplasty.
  10. Plans for pregnancy during the course of the study for women of child-bearing potential
  11. History of or planning bariatric surgery, including banding procedures or surgical gastric and/or intestinal bypass (if banding removed, may be considered eligible after 1 year)
  12. History of congestive heart failure (NYHA 3 or greater)
  13. History of pancreatitis
  14. History of cancer, other than non-melanoma skin cancer, that required therapy in the 5 years prior to randomization
  15. Personal or family history of MEN-2 or family history of medullary thyroid cancer
  16. Estimated GFR (eGFR) <30 ml/min/1.73 m2 or end stage renal disease requiring renal replacement therapy
  17. History of severe liver disease or acute hepatitis or ALT > 3 times upper limit of normal
  18. Current alcoholism or excessive alcohol intake
  19. Previous organ transplant
  20. Treatment with oral or systemic glucocorticoids (other than short-term treatment, for example for poison ivy) or disease likely to require periodic or regular glucocorticoid therapy (inhaled steroids are allowed)
  21. Treatment with atypical antipsychotics
  22. History of hemolytic anemia, chronic transfusion requirement, or other condition rendering HbA1c results unreliable as indicator of chronic glucose levels, or hematocrit <35 for males and <33 for females
  23. Clinically or medically unstable with expected survival <1 year
  24. Unwillingness to permit sites to contact the PCP to communicate information about the study and the participant's data
  25. No non-study PCP or inability to identify such a PCP (who will provide non-study care) by the time of final run-in
  26. Participation in another interventional clinical trial
  27. Previous randomization in the GRADE study
  28. In the opinion of the principal investigator (PI), any other factor, including language barrier, likely to limit compliance with the protocol
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01794143

Contact: Heidi Krause-Steinrauf, MS
Contact: Claire Stevens

  Hide Study Locations
United States, Alabama
University of Alabama-Birmingham Recruiting
Birmingham, Alabama, United States
Contact: Dana Rigsby Golson    205-996-4015   
Contact: April Agne    205-996-4015   
Principal Investigator: Timothy Garvey         
Sub-Investigator: Andrea Cherrington         
United States, Arizona
Southwestern American Indian Center Recruiting
Phoenix, Arizona, United States
Contact: Tina Killean    602-200-5337   
Contact: Erica Joshevama    602-200-5337   
Principal Investigator: Jonathan Krakoff         
United States, California
Veterans Medical Research Foundation, San Diego (San Diego VA) Recruiting
San Diego, California, United States
Contact: Elsa Diaz    858-552-8585 ext 2711   
Contact: Catherine Delue    858-552-8585 ext 6740   
Principal Investigator: Robert Henry         
United States, Colorado
University of Colorado Recruiting
Denver, Colorado, United States
Contact: Chantal Underkofler    303-399-8020 ext 2059   
Principal Investigator: Neda Rasouli         
United States, Connecticut
Yale University School of Medicine Recruiting
New Haven, Connecticut, United States
Contact: Patricia Gatcomb    203-764-8463   
Contact: Magalys Perez    203-752-5268   
Principal Investigator: William Tamborlane         
Sub-Investigator: Anne Camp         
United States, Florida
South Florida VA Foundation (Miami VA) Recruiting
Miami, Florida, United States
Contact: Miriam Gutt    305-575-7290   
Contact: Lisset Oropesa    305-243-1473   
Principal Investigator: Hermes Flores         
Sub-Investigator: Willy Valencia         
United States, Georgia
Atlanta VA Medical Center Recruiting
Decatur, Georgia, United States
Contact: Stephanie Raines    404-235-3024   
Principal Investigator: Lawrence Phillips         
Kaiser Permanente of Georgia Active, not recruiting
Duluth, Georgia, United States
United States, Hawaii
Pacific Health Research and Education Institute (VA Pacific Islands) Recruiting
Honolulu, Hawaii, United States
Contact: Mike Matwichyna    808-564-5700   
Principal Investigator: Helen Petrovitch         
United States, Indiana
Indiana University School of Medicine Recruiting
Indianapolis, Indiana, United States
Contact: Tonya Hamilton    317-274-7679   
Principal Investigator: Kieren Mather         
United States, Iowa
University of Iowa Recruiting
Iowa City, Iowa, United States
Contact: Laura Knosp    319-384-5369   
Contact: Tamara Lowe    309-384-8103   
Principal Investigator: William Sivitz         
United States, Louisiana
Pennington Biomedical Research Center Active, not recruiting
Baton Rouge, Louisiana, United States
United States, Maryland
MedStar Health Research Institute Recruiting
Hyattsville, Maryland, United States
Contact: Amy Smith Loveland    301-560-2915   
Contact: Florence Mofor    443-444-3644   
Principal Investigator: Vanita Aroda         
United States, Massachusetts
Massachusetts General Hospital Recruiting
Boston, Massachusetts, United States
Contact: Andrea deManbey    617-724-7851   
Principal Investigator: Deborah Wexler         
United States, Michigan
University of Michigan Recruiting
Ann Arbor, Michigan, United States
Contact: Andrea Waltje    855-566-6559      
Principal Investigator: William Herman         
Sub-Investigator: Rodica Pop-Busui         
United States, Minnesota
International Diabetes Center Recruiting
Minneapolis, Minnesota, United States
Contact: Renae Hill    952-993-9605   
Contact: Connie Jensen   
Principal Investigator: Richard Bergenstal         
University of Minnesota Recruiting
Minneapolis, Minnesota, United States
Contact: Michael Mech    612-626-0143   
Contact: Mary Coe    612-626-0143   
Principal Investigator: Elizabeth Seaquist         
United States, Missouri
Washington University School of Medicine Active, not recruiting
Saint Louis, Missouri, United States
United States, Nebraska
University of Nebraska Recruiting
Omaha, Nebraska, United States
Contact: Grace Rodriguez    402-559-6244   
Contact: Kris Seipel    402-995-4121   
Principal Investigator: Cyrus Desouza         
United States, New Mexico
University of New Mexico School of Medicine Recruiting
Albuquerque, New Mexico, United States
Contact: Elizabeth Duran-Valdez    505-272-5454   
Principal Investigator: David Schade         
United States, New York
State University of New York (SUNY)-Downstate Medical Center Recruiting
Brooklyn, New York, United States
Contact: Necole Brown    718-270-4693      
Contact: Mari Tsovian    718-670-14827   
Principal Investigator: Mary Ann Benerji         
Sub-Investigator: Daniel Lorber         
Columbia University Naomi Berrie Diabetes Center Recruiting
New York, New York, United States
Contact: James Pring    212-851-5449   
Contact: Camille Hausheer    212-851-5449      
Principal Investigator: Robin Goland         
Mount Sinai St. Luke's Hospital Recruiting
New York, New York, United States
Principal Investigator: Xavier Pi-Sunyer         
Albert Einstein College of Medicine Recruiting
The Bronx, New York, United States
Contact: Janet Brown-Friday    718-839-7941   
Principal Investigator: Jill Crandall         
Sub-Investigator: Diane McKee         
United States, North Carolina
Duke University Medical Center Recruiting
Durham, North Carolina, United States
Contact: Jennifer E Jones    919-681-3574   
Principal Investigator: Jennifer Green         
University of North Carolina Diabetes Care Center Recruiting
Durham, North Carolina, United States
Contact: Sonia Guarda    984-974-3003   
Principal Investigator: Sue Kirkman         
Sub-Investigator: John Buse         
United States, Ohio
University of Cincinnati Recruiting
Cincinnati, Ohio, United States
Contact: Jacqueline Craig    513-861-3100 ext 4715   
Contact: Colleen Rogge    513-475-6478   
Principal Investigator: Robert Cohen         
Case Western Reserve University School of Medicine Recruiting
Cleveland, Ohio, United States
Contact: Margaret Tiktin    216-231-3240      
Contact: Cindy Newman    216-778-3237      
Principal Investigator: Faramarz Ismail-Beigi         
Sub-Investigator: Corinna Falck-Ytter         
United States, Oregon
Kaiser Permanente Northwest Recruiting
Portland, Oregon, United States
Contact: Britta Torgrimson-Ojerio (Kaiser Members Only)    503-571-3802 ext (Tues, Fri)   
Contact: Britta Torgrimson-Ojerio (Kaiser Members Only)    503-331-6017 ext (M, W, Th)   
Principal Investigator: Stephen Fortman         
Oregon Health and Science University Recruiting
Portland, Oregon, United States
Contact: Nancy Cady    503-494-4650   
Principal Investigator: Andrew Ahmann         
United States, Tennessee
Vanderbilt University Medical Center Recruiting
Nashville, Tennessee, United States
Contact: Stephanie Martin    615-936-1075    stephanie.michon@Vanderbilt.Edu   
Contact: Laurie Shackleford   
United States, Texas
Baylor Endocrine Center Recruiting
Dallas, Texas, United States
Contact: Analyn Uy    214-820-4774   
Principal Investigator: Priscilla Hollander         
University of Texas-Southwestern Medical Center Recruiting
Dallas, Texas, United States
Contact: Soma Abraham    214-648-4561   
Principal Investigator: Philip Raskin         
Baylor College of Medicine Recruiting
Houston, Texas, United States
Contact: Erica Gonzalez    713-798-3625      
Contact: Charlyne Wright    713-798-3625      
Principal Investigator: Ashok Balasubramanyam         
University of Texas Health Science Center Recruiting
San Antonio, Texas, United States
Contact: Hector Verastigui    210-358-7200      
Contact: R Irene Garza    210-358-7200      
Principal Investigator: Ralph DeFronzo         
United States, Washington
Seattle Institute for Biomedical and Clinical Research Recruiting
Seattle, Washington, United States
Contact: Basma Fattaleh    206-227-4013      
Principal Investigator: Kristina Utzschneider         
Sponsors and Collaborators
GRADE Study Group
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
National Heart, Lung, and Blood Institute (NHLBI)
Becton, Dickinson and Company
Bristol-Myers Squibb
Merck Sharp & Dohme Corp.
Novo Nordisk A/S
Roche Diagnostics
Study Chair: David M Nathan, MD Massachusetts General Hospital
  More Information

Responsible Party: GRADE Study Group Identifier: NCT01794143     History of Changes
Other Study ID Numbers: GRADE
1U01DK098246-01 ( US NIH Grant/Contract Award Number )
Study First Received: February 13, 2013
Last Updated: June 22, 2017

Keywords provided by GRADE Study Group:
Treatment of Type 2 diabetes
Comparative effectiveness research
Clinical trial
Patient-centered outcomes

Additional relevant MeSH terms:
Diabetes Mellitus
Diabetes Mellitus, Type 2
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases
Insulin, Globin Zinc
Sitagliptin Phosphate
Insulin Glargine
Dipeptidyl-Peptidase IV Inhibitors
Hypoglycemic Agents
Physiological Effects of Drugs
Hormones, Hormone Substitutes, and Hormone Antagonists
Protease Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Anti-Arrhythmia Agents
Immunosuppressive Agents
Immunologic Factors processed this record on June 28, 2017