Medication Adherence in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE)
Authors' conclusion
Medication adherence was consistently high in GRADE. Observed treatment group differences were small and of unclear clinical significance. Overall, lower adherence robustly predicted worsening glycemic control, highlighting the importance of ongoing assessment.
Study context
- Population
- T2D duration <10 years, HbA1c 6.8%-8.5%, on metformin alonesubstudy
- Participants
- 1,739 participants
- Comparison
- Insulin glargine vs glimepiride vs liraglutide vs sitagliptin added to metformin
- Primary endpoint
- Medication adherence on a validated three-item scale (0-100, lowest to highest adherence), measured semiannually
- Follow-up
- 3 years
Methodological detailssubstudy
- Substudy
Primary result
As reported in the abstract
Overall mean ± SD adherence
88.7 ± 10.01
Change by 3 years vs baseline
−2.0 ± 14.7
P < 0.0001
At 3 years, adherence higher for glimepiride vs liraglutide (P < 0.05)
5%
At 3 years, adherence higher for sitagliptin vs liraglutide (P < 0.05)
3%
Secondary outcomes
Association of 10-point decrease in adherence with glycemic outcomes, across groups · over follow-up
- Increased risk of primary outcome (HbA1c ≥7.0%) (P < 0.0001)
- 15%
- Increased risk of secondary outcome (HbA1c >7.5%) (P < 0.0001)
- 19%
Treatment group differences in adherence–outcome association
- Lower adherence somewhat more predictive of secondary outcome with glargine or liraglutide vs glimepiride or sitagliptin (each P < 0.05); no other comparisons significant
Original publication
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