Cardiovascular Outcomes in GRADE (Glycemia Reduction Approaches in Type 2 Diabetes: A Comparative Effectiveness Study)
Authors' conclusion
This comparative effectiveness study of a contemporary cohort of adults with type 2 diabetes, largely without established cardiovascular disease, suggests that liraglutide treatment may reduce the risk of cardiovascular events in patients at relatively low risk compared with other commonly used glucose-lowering medications.
Study context
- Population
- Adults with T2DM (mean duration 4.0 years) and low baseline prevalence of CVD (MI 5.1%; stroke 2.0%), on metformin
- Participants
- 5,047 adults
- Comparison
- Insulin glargine vs Glimepiride vs Liraglutide vs Sitagliptin
- Primary endpoint
- Time to first MACE-3 (CV death, MI, stroke), MACE-4 (+unstable angina requiring hospitalization or revascularization), MACE-5 (+coronary revascularization), MACE-6 (+hospitalization for HF) and individual components
- Follow-up
- Median 5 years
Methodological detailscomparative effectiveness, prespecified outcomes
- Comparative effectiveness
- Prespecified outcomes
Primary result
As reported in the abstract
First MACE-3, MACE-4, MACE-5, MACE-6 and components, by randomised group
- No statistically significant differences in cumulative incidence of first MACE-3, MACE-4, MACE-5, MACE-6 or their components by randomised group
Further findings
| Outcome | Estimate | P value | |
|---|---|---|---|
| MACE-5, MACE-6 and hospitalization for HF: liraglutide vs other groups combinedLiraglutide vs Other groups combined · MACE-5 | adjusted HR 0.70 (95% CI 0.54–0.91) | P = 0.021 | |
| MACE-5, MACE-6 and hospitalization for HF: liraglutide vs other groups combinedLiraglutide vs Other groups combined · MACE-6 | adjusted HR 0.70 (95% CI 0.55–0.90) | P = 0.021 | |
| MACE-5, MACE-6 and hospitalization for HF: liraglutide vs other groups combinedLiraglutide vs Other groups combined · hospitalization for HF | adjusted HR 0.49 (95% CI 0.28–0.86) | P = 0.022 | |
| Recurrent MACE-6 events (proportional rate model)Glimepiride vs Liraglutide | rate ratio 1.61 (95% CI 1.13–2.29) | ||
| Recurrent MACE-6 events (proportional rate model)Sitagliptin vs Liraglutide | rate ratio 1.75 (95% CI 1.24–2.48) | ||
| 0.20.5125Ratio (log scale) |
Original publication
Cardiovascular Outcomes in GRADE (Glycemia Reduction Approaches in Type 2 Diabetes: A Comparative Effectiveness Study). Circulation. Published 12 February 2024. doi:10.
Summarised from the published abstract; every number is checked against it