TY  - BOOK
AU  - Aroda, Vanita R
TI  - Optimization of Metformin in the GRADE Cohort: Effect on Glycemia and Body Weight
SN  - 0149-5992
PY  - 2020///
KW  - *Blood Glucose/de [Drug Effects]
KW  - *Body Weight/de [Drug Effects]
KW  - *Diabetes Mellitus, Type 2/dt [Drug Therapy]
KW  - *Hypoglycemic Agents/ad [Administration & Dosage]
KW  - *Metformin/ad [Administration & Dosage]
KW  - Adult
KW  - Aged
KW  - Blood Glucose/me [Metabolism]
KW  - Calibration
KW  - Comparative Effectiveness Research
KW  - Diabetes Mellitus, Type 2/bl [Blood]
KW  - Dose-Response Relationship, Drug
KW  - Drug Therapy, Combination
KW  - Female
KW  - Glycated Hemoglobin A/an [Analysis]
KW  - Glycated Hemoglobin A/me [Metabolism]
KW  - Humans
KW  - Hypoglycemic Agents/ae [Adverse Effects]
KW  - Insulin/aa [Analogs & Derivatives]
KW  - Insulin/ad [Administration & Dosage]
KW  - Insulin/ae [Adverse Effects]
KW  - Liraglutide/ad [Administration & Dosage]
KW  - Liraglutide/ae [Adverse Effects]
KW  - Male
KW  - Maximum Tolerated Dose
KW  - Metformin/ae [Adverse Effects]
KW  - Middle Aged
KW  - Sitagliptin Phosphate/ad [Administration & Dosage]
KW  - Sitagliptin Phosphate/ae [Adverse Effects]
KW  - Sulfonylurea Compounds/ad [Administration & Dosage]
KW  - Sulfonylurea Compounds/ae [Adverse Effects]
KW  - Weight Loss/de [Drug Effects]
KW  - Weight Loss/ph [Physiology]
KW  - MedStar Health Research Institute
KW  - Journal Article
N2  - CONCLUSIONS: Optimizing metformin to 2,000 mg/day or a maximally tolerated lower dose combined with emphasis on medication adherence and lifestyle can  improve glycemia in type 2 diabetes and HbA1c values >=6.8% (51 mmol/mol). These findings may help guide efforts to optimize metformin therapy among persons  with type 2 diabetes and suboptimal glycemic control. Copyright (c) 2020 by the American Diabetes Association; OBJECTIVE: We evaluated the effect of optimizing metformin dosing on glycemia and body weight in type 2 diabetes; RESEARCH DESIGN AND METHODS: This was a prespecified analysis of 6,823 participants in the Glycemia Reduction Approaches in Diabetes: A Comparative  Effectiveness Study (GRADE) taking metformin as the sole glucose-lowering drug who completed a 4- to 14-week (mean +/- SD 7.9 +/- 2.4) run-in in which  metformin was adjusted to 2,000 mg/day or a maximally tolerated lower dose. Participants had type 2 diabetes for <10 years and an HbA1c >=6.8% (51 mmol/mol)  while taking >=500 mg of metformin/day. Participants also received diet and exercise counseling. The primary outcome was the change in HbA1c during run-in; RESULTS: Adjusted for duration of run-in, the mean +/- SD change in HbA1c was -0.65 +/- 0.02% (-7.1 +/- 0.2 mmol/mol) when the dose was increased by  >=1,000 mg/day, -0.48 +/- 0.02% (-5.2 +/- 0.2 mmol/mol) when the dose was unchanged, and -0.23 +/- 0.07% (-2.5 +/- 0.8 mmol/mol) when the dose was decreased  (n = 2,169, 3,548, and 192, respectively). Higher HbA1c at entry predicted greater reduction in HbA1c (P < 0.001) in univariate and multivariate analyses.  Weight loss adjusted for duration of run-in averaged 0.91 +/- 0.05 kg in participants who increased metformin by >=1,000 mg/day (n = 1,894)
UR  - https://dx.doi.org/10.2337/dc19-1769
ER  -