Optimization of Metformin in the GRADE Cohort: Effect on Glycemia and Body Weight.
Citation: Diabetes Care. 43(5):940-947, 2020 05.PMID: 32139384Institution: MedStar Health Research InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Blood Glucose/de [Drug Effects] | *Body Weight/de [Drug Effects] | *Diabetes Mellitus, Type 2/dt [Drug Therapy] | *Hypoglycemic Agents/ad [Administration & Dosage] | *Metformin/ad [Administration & Dosage] | Adult | Aged | Blood Glucose/me [Metabolism] | Calibration | Comparative Effectiveness Research | Diabetes Mellitus, Type 2/bl [Blood] | Dose-Response Relationship, Drug | Drug Therapy, Combination | Female | Glycated Hemoglobin A/an [Analysis] | Glycated Hemoglobin A/me [Metabolism] | Humans | Hypoglycemic Agents/ae [Adverse Effects] | Insulin/aa [Analogs & Derivatives] | Insulin/ad [Administration & Dosage] | Insulin/ae [Adverse Effects] | Liraglutide/ad [Administration & Dosage] | Liraglutide/ae [Adverse Effects] | Male | Maximum Tolerated Dose | Metformin/ae [Adverse Effects] | Middle Aged | Sitagliptin Phosphate/ad [Administration & Dosage] | Sitagliptin Phosphate/ae [Adverse Effects] | Sulfonylurea Compounds/ad [Administration & Dosage] | Sulfonylurea Compounds/ae [Adverse Effects] | Weight Loss/de [Drug Effects] | Weight Loss/ph [Physiology]Year: 2020ISSN:- 0149-5992
- Aroda, Vanita R:
- https://orcid.org/0000-0002-7706-4585
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
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Journal Article | MedStar Authors Catalog | Article | 32139384 | Available | 32139384 |
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).
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