Clinical and Metabolic Characterization of Adults With Type 2 Diabetes by Age in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) Cohort
OBJECTIVE Differences in type 2 diabetes phenotype by age are described, but it is not known whether these differences are seen in a more uniformly defined adult population at a common early stage of care. We sought to characterize age-related clinical and metabolic characteristics of adults with ty...
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| Veröffentlicht in: | Diabetes care 2022-07, Vol.45 (7), p.1512-1521 |
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| creator | Aroda, Vanita R. Krause-Steinrauf, Heidi Kazemi, Erin J. Buse, John B. Gulanski, Barbara I. Florez, Hermes J. Ahmann, Andrew J. Loveland, Amy Kuhn, Alexander Lonier, Jacqueline Y. Wexler, Deborah J. Crandall, J.P. McKee, M.D. Behringer-Massera, S. Brown-Friday, J. Xhori, E. Ballentine-Cargill, K. Duran, S. Estrella, H. Gonzalez de la torre, S. Lukin, J. Phillips, L.S. Burgess, E. Olson, D. Rhee, M. Wilson, P. Raines, T.S. Boers, J. Costello, J. Maher-Albertelli, M. Mungara, R. Savoye, L. White, C.A. Gullett, C. Holloway, L. Morehead, F. Person, S. Sibymon, M. Tanukonda, S. Adams, C. Ross, A. Balasubramanyam, A. Gaba, R. Gonzalez Hattery, E. Ideozu, A. Jimenez, J. Montes, G. Wright, C. Hollander, P. Roe, E. Jackson, A. Smiley, A. Burt, P. Estrada, L. Chionh, K. Ismail-Beigi, F. Falck-Ytter, C. Sayyed Kassem, L. Sood, A. Tiktin, M. Kulow, T. Newman, C. Stancil, K.A. Cramer, B. Iacoboni, J. Kononets, M.V. Sanders, C. Tucker, L. Werner, A. Maxwell, A. McPhee, G. Patel, C. Colosimo, L. Krol, A. Goland, R. Pring, J. Alfano, L. Kringas, P. Hausheer, C. Tejada, J. Gumpel, K. Kirpitch, A. Schneier, H. Green, J.B. AbouAssi, H. Chatterjee, R. Feinglos, M.N. English Jones, J. Khan, S.A. Kimpel, J.B. Zimmer, R.P. Furst, M. Satterwhite, B.M. Thacker, C.R. Evans Kreider, K. Mariash, C.N. Mather, K.J. Ismail, H.M. Lteif, A. Mullen, M. |
| description | OBJECTIVE Differences in type 2 diabetes phenotype by age are described, but it is not known whether these differences are seen in a more uniformly defined adult population at a common early stage of care. We sought to characterize age-related clinical and metabolic characteristics of adults with type 2 diabetes on metformin monotherapy, prior to treatment intensification. RESEARCH DESIGN AND METHODS In the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE), participants were enrolled who had type 2 diabetes duration |
| doi_str_mv | 10.2337/dc21-2659 |
| format | Article |
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We sought to characterize age-related clinical and metabolic characteristics of adults with type 2 diabetes on metformin monotherapy, prior to treatment intensification. RESEARCH DESIGN AND METHODS In the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE), participants were enrolled who had type 2 diabetes duration <10 years, had HbA1c 6.8–8.5%, and were on metformin monotherapy. Participants were randomly assigned to one of four additional glucose-lowering medications. We compared baseline clinical and metabolic characteristics across age categories (<45, 45 to <55, 55 to <65, and ≥65 years) using ANOVA and Pearson χ2 tests. RESULTS Within the GRADE cohort (n = 5,047), we observed significant differences by age, with younger adults having greater racial diversity, fewer medications for common comorbidities, lower prevalence of CVD, higher weight and BMI, and more pronounced hyperglycemia and diabetic dyslipidemia and with metabolic profile indicating lower insulin sensitivity (inverse fasting insulin [1/(fasting insulin)], HOMA of steady-state insulin sensitivity, Matsuda index) and inadequate β-cell response (oral disposition index) (P < 0.05 across age categories). CONCLUSIONS Clinical and metabolic characteristics of type 2 diabetes differ by age within the GRADE cohort. Younger adults exhibit more prominent obesity-related characteristics, including higher obesity levels and lower insulin sensitivity and β-cell compensation. Given the increasing burden of type 2 diabetes and complications, particularly among younger populations, these age-related distinctions may inform risk factor management approaches and treatment priorities. Further study will determine whether age-related differences impact response to therapy.</description><identifier>ISSN: 0149-5992</identifier><identifier>EISSN: 1935-5548</identifier><identifier>DOI: 10.2337/dc21-2659</identifier><language>eng</language><publisher>Alexandria: American Diabetes Association</publisher><subject>Adults ; Age ; Antidiabetics ; Beta cells ; Blood glucose ; Clinical Care/Education/Nutrition/Psychosocial Research ; Comorbidity ; Complications ; Diabetes ; Diabetes mellitus ; Diabetes mellitus (non-insulin dependent) ; Dyslipidemia ; Effectiveness studies ; Fasting ; Genotype & phenotype ; Hyperglycemia ; Impact response ; Insulin ; Laboratory testing ; Metabolism ; Metformin ; Obesity ; Phenotypes ; Race ; Reduction ; Risk analysis ; Risk factors ; Risk management ; Sensitivity ; Variance analysis</subject><ispartof>Diabetes care, 2022-07, Vol.45 (7), p.1512-1521</ispartof><rights>Copyright American Diabetes Association Jul 2022</rights><rights>2022 by the American Diabetes Association 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c307t-de726cf17dffa84534bb7acd9b3d2babbaa53a40477ab22eaea8cfc5bbf65b2f3</cites><orcidid>0000-0002-7706-4585</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids></links><search><creatorcontrib>Aroda, Vanita R.</creatorcontrib><creatorcontrib>Krause-Steinrauf, Heidi</creatorcontrib><creatorcontrib>Kazemi, Erin J.</creatorcontrib><creatorcontrib>Buse, John B.</creatorcontrib><creatorcontrib>Gulanski, Barbara I.</creatorcontrib><creatorcontrib>Florez, Hermes J.</creatorcontrib><creatorcontrib>Ahmann, Andrew J.</creatorcontrib><creatorcontrib>Loveland, Amy</creatorcontrib><creatorcontrib>Kuhn, Alexander</creatorcontrib><creatorcontrib>Lonier, Jacqueline Y.</creatorcontrib><creatorcontrib>Wexler, Deborah J.</creatorcontrib><creatorcontrib>Crandall, J.P.</creatorcontrib><creatorcontrib>McKee, M.D.</creatorcontrib><creatorcontrib>Behringer-Massera, S.</creatorcontrib><creatorcontrib>Brown-Friday, J.</creatorcontrib><creatorcontrib>Xhori, E.</creatorcontrib><creatorcontrib>Ballentine-Cargill, K.</creatorcontrib><creatorcontrib>Duran, S.</creatorcontrib><creatorcontrib>Estrella, H.</creatorcontrib><creatorcontrib>Gonzalez de la torre, S.</creatorcontrib><creatorcontrib>Lukin, J.</creatorcontrib><creatorcontrib>Phillips, L.S.</creatorcontrib><creatorcontrib>Burgess, E.</creatorcontrib><creatorcontrib>Olson, D.</creatorcontrib><creatorcontrib>Rhee, M.</creatorcontrib><creatorcontrib>Wilson, P.</creatorcontrib><creatorcontrib>Raines, T.S.</creatorcontrib><creatorcontrib>Boers, J.</creatorcontrib><creatorcontrib>Costello, J.</creatorcontrib><creatorcontrib>Maher-Albertelli, M.</creatorcontrib><creatorcontrib>Mungara, R.</creatorcontrib><creatorcontrib>Savoye, L.</creatorcontrib><creatorcontrib>White, C.A.</creatorcontrib><creatorcontrib>Gullett, C.</creatorcontrib><creatorcontrib>Holloway, L.</creatorcontrib><creatorcontrib>Morehead, F.</creatorcontrib><creatorcontrib>Person, S.</creatorcontrib><creatorcontrib>Sibymon, M.</creatorcontrib><creatorcontrib>Tanukonda, S.</creatorcontrib><creatorcontrib>Adams, C.</creatorcontrib><creatorcontrib>Ross, A.</creatorcontrib><creatorcontrib>Balasubramanyam, A.</creatorcontrib><creatorcontrib>Gaba, R.</creatorcontrib><creatorcontrib>Gonzalez Hattery, E.</creatorcontrib><creatorcontrib>Ideozu, A.</creatorcontrib><creatorcontrib>Jimenez, J.</creatorcontrib><creatorcontrib>Montes, G.</creatorcontrib><creatorcontrib>Wright, C.</creatorcontrib><creatorcontrib>Hollander, P.</creatorcontrib><creatorcontrib>Roe, E.</creatorcontrib><creatorcontrib>Jackson, A.</creatorcontrib><creatorcontrib>Smiley, A.</creatorcontrib><creatorcontrib>Burt, P.</creatorcontrib><creatorcontrib>Estrada, L.</creatorcontrib><creatorcontrib>Chionh, K.</creatorcontrib><creatorcontrib>Ismail-Beigi, F.</creatorcontrib><creatorcontrib>Falck-Ytter, C.</creatorcontrib><creatorcontrib>Sayyed Kassem, L.</creatorcontrib><creatorcontrib>Sood, A.</creatorcontrib><creatorcontrib>Tiktin, M.</creatorcontrib><creatorcontrib>Kulow, T.</creatorcontrib><creatorcontrib>Newman, C.</creatorcontrib><creatorcontrib>Stancil, K.A.</creatorcontrib><creatorcontrib>Cramer, B.</creatorcontrib><creatorcontrib>Iacoboni, J.</creatorcontrib><creatorcontrib>Kononets, M.V.</creatorcontrib><creatorcontrib>Sanders, C.</creatorcontrib><creatorcontrib>Tucker, L.</creatorcontrib><creatorcontrib>Werner, A.</creatorcontrib><creatorcontrib>Maxwell, A.</creatorcontrib><creatorcontrib>McPhee, G.</creatorcontrib><creatorcontrib>Patel, C.</creatorcontrib><creatorcontrib>Colosimo, L.</creatorcontrib><creatorcontrib>Krol, A.</creatorcontrib><creatorcontrib>Goland, R.</creatorcontrib><creatorcontrib>Pring, J.</creatorcontrib><creatorcontrib>Alfano, L.</creatorcontrib><creatorcontrib>Kringas, P.</creatorcontrib><creatorcontrib>Hausheer, C.</creatorcontrib><creatorcontrib>Tejada, J.</creatorcontrib><creatorcontrib>Gumpel, K.</creatorcontrib><creatorcontrib>Kirpitch, A.</creatorcontrib><creatorcontrib>Schneier, H.</creatorcontrib><creatorcontrib>Green, J.B.</creatorcontrib><creatorcontrib>AbouAssi, H.</creatorcontrib><creatorcontrib>Chatterjee, R.</creatorcontrib><creatorcontrib>Feinglos, M.N.</creatorcontrib><creatorcontrib>English Jones, J.</creatorcontrib><creatorcontrib>Khan, S.A.</creatorcontrib><creatorcontrib>Kimpel, J.B.</creatorcontrib><creatorcontrib>Zimmer, R.P.</creatorcontrib><creatorcontrib>Furst, M.</creatorcontrib><creatorcontrib>Satterwhite, B.M.</creatorcontrib><creatorcontrib>Thacker, C.R.</creatorcontrib><creatorcontrib>Evans Kreider, K.</creatorcontrib><creatorcontrib>Mariash, C.N.</creatorcontrib><creatorcontrib>Mather, K.J.</creatorcontrib><creatorcontrib>Ismail, H.M.</creatorcontrib><creatorcontrib>Lteif, A.</creatorcontrib><creatorcontrib>Mullen, M.</creatorcontrib><creatorcontrib>GRADE Research Group</creatorcontrib><title>Clinical and Metabolic Characterization of Adults With Type 2 Diabetes by Age in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) Cohort</title><title>Diabetes care</title><description>OBJECTIVE Differences in type 2 diabetes phenotype by age are described, but it is not known whether these differences are seen in a more uniformly defined adult population at a common early stage of care. We sought to characterize age-related clinical and metabolic characteristics of adults with type 2 diabetes on metformin monotherapy, prior to treatment intensification. RESEARCH DESIGN AND METHODS In the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE), participants were enrolled who had type 2 diabetes duration <10 years, had HbA1c 6.8–8.5%, and were on metformin monotherapy. Participants were randomly assigned to one of four additional glucose-lowering medications. We compared baseline clinical and metabolic characteristics across age categories (<45, 45 to <55, 55 to <65, and ≥65 years) using ANOVA and Pearson χ2 tests. RESULTS Within the GRADE cohort (n = 5,047), we observed significant differences by age, with younger adults having greater racial diversity, fewer medications for common comorbidities, lower prevalence of CVD, higher weight and BMI, and more pronounced hyperglycemia and diabetic dyslipidemia and with metabolic profile indicating lower insulin sensitivity (inverse fasting insulin [1/(fasting insulin)], HOMA of steady-state insulin sensitivity, Matsuda index) and inadequate β-cell response (oral disposition index) (P < 0.05 across age categories). CONCLUSIONS Clinical and metabolic characteristics of type 2 diabetes differ by age within the GRADE cohort. Younger adults exhibit more prominent obesity-related characteristics, including higher obesity levels and lower insulin sensitivity and β-cell compensation. Given the increasing burden of type 2 diabetes and complications, particularly among younger populations, these age-related distinctions may inform risk factor management approaches and treatment priorities. Further study will determine whether age-related differences impact response to therapy.</description><subject>Adults</subject><subject>Age</subject><subject>Antidiabetics</subject><subject>Beta cells</subject><subject>Blood glucose</subject><subject>Clinical Care/Education/Nutrition/Psychosocial Research</subject><subject>Comorbidity</subject><subject>Complications</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>Dyslipidemia</subject><subject>Effectiveness studies</subject><subject>Fasting</subject><subject>Genotype & phenotype</subject><subject>Hyperglycemia</subject><subject>Impact response</subject><subject>Insulin</subject><subject>Laboratory testing</subject><subject>Metabolism</subject><subject>Metformin</subject><subject>Obesity</subject><subject>Phenotypes</subject><subject>Race</subject><subject>Reduction</subject><subject>Risk analysis</subject><subject>Risk 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H.M.</creator><creator>Lteif, A.</creator><creator>Mullen, M.</creator><general>American Diabetes Association</general><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-7706-4585</orcidid></search><sort><creationdate>20220701</creationdate><title>Clinical and Metabolic Characterization of Adults With Type 2 Diabetes by Age in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) Cohort</title><author>Aroda, Vanita R. ; Krause-Steinrauf, Heidi ; Kazemi, Erin J. ; Buse, John B. ; Gulanski, Barbara I. ; Florez, Hermes J. ; Ahmann, Andrew J. ; Loveland, Amy ; Kuhn, Alexander ; Lonier, Jacqueline Y. ; Wexler, Deborah J. ; Crandall, J.P. ; McKee, M.D. ; Behringer-Massera, S. ; Brown-Friday, J. ; Xhori, E. ; Ballentine-Cargill, K. ; Duran, S. ; Estrella, H. ; Gonzalez de la torre, S. ; Lukin, J. ; Phillips, L.S. ; Burgess, E. ; Olson, D. ; Rhee, M. ; Wilson, P. ; Raines, T.S. ; Boers, J. ; Costello, J. ; Maher-Albertelli, M. ; Mungara, R. ; Savoye, L. ; White, C.A. ; Gullett, C. ; Holloway, L. ; Morehead, F. ; Person, S. ; Sibymon, M. ; Tanukonda, S. ; Adams, C. ; Ross, A. ; Balasubramanyam, A. ; Gaba, R. ; Gonzalez Hattery, E. ; Ideozu, A. ; Jimenez, J. ; Montes, G. ; Wright, C. ; Hollander, P. ; Roe, E. ; Jackson, A. ; Smiley, A. ; Burt, P. ; Estrada, L. ; Chionh, K. ; Ismail-Beigi, F. ; Falck-Ytter, C. ; Sayyed Kassem, L. ; Sood, A. ; Tiktin, M. ; Kulow, T. ; Newman, C. ; Stancil, K.A. ; Cramer, B. ; Iacoboni, J. ; Kononets, M.V. ; Sanders, C. ; Tucker, L. ; Werner, A. ; Maxwell, A. ; McPhee, G. ; Patel, C. ; Colosimo, L. ; Krol, A. ; Goland, R. ; Pring, J. ; Alfano, L. ; Kringas, P. ; Hausheer, C. ; Tejada, J. ; Gumpel, K. ; Kirpitch, A. ; Schneier, H. ; Green, J.B. ; AbouAssi, H. ; Chatterjee, R. ; Feinglos, M.N. ; English Jones, J. ; Khan, S.A. ; Kimpel, J.B. ; Zimmer, R.P. ; Furst, M. ; Satterwhite, B.M. ; Thacker, C.R. ; Evans Kreider, K. ; Mariash, C.N. ; Mather, K.J. ; Ismail, H.M. ; Lteif, A. ; Mullen, M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c307t-de726cf17dffa84534bb7acd9b3d2babbaa53a40477ab22eaea8cfc5bbf65b2f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adults</topic><topic>Age</topic><topic>Antidiabetics</topic><topic>Beta cells</topic><topic>Blood glucose</topic><topic>Clinical Care/Education/Nutrition/Psychosocial Research</topic><topic>Comorbidity</topic><topic>Complications</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Diabetes mellitus (non-insulin dependent)</topic><topic>Dyslipidemia</topic><topic>Effectiveness studies</topic><topic>Fasting</topic><topic>Genotype & phenotype</topic><topic>Hyperglycemia</topic><topic>Impact response</topic><topic>Insulin</topic><topic>Laboratory testing</topic><topic>Metabolism</topic><topic>Metformin</topic><topic>Obesity</topic><topic>Phenotypes</topic><topic>Race</topic><topic>Reduction</topic><topic>Risk analysis</topic><topic>Risk factors</topic><topic>Risk management</topic><topic>Sensitivity</topic><topic>Variance analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Aroda, Vanita R.</creatorcontrib><creatorcontrib>Krause-Steinrauf, Heidi</creatorcontrib><creatorcontrib>Kazemi, Erin J.</creatorcontrib><creatorcontrib>Buse, John B.</creatorcontrib><creatorcontrib>Gulanski, Barbara I.</creatorcontrib><creatorcontrib>Florez, Hermes J.</creatorcontrib><creatorcontrib>Ahmann, Andrew J.</creatorcontrib><creatorcontrib>Loveland, Amy</creatorcontrib><creatorcontrib>Kuhn, Alexander</creatorcontrib><creatorcontrib>Lonier, Jacqueline Y.</creatorcontrib><creatorcontrib>Wexler, Deborah J.</creatorcontrib><creatorcontrib>Crandall, J.P.</creatorcontrib><creatorcontrib>McKee, M.D.</creatorcontrib><creatorcontrib>Behringer-Massera, S.</creatorcontrib><creatorcontrib>Brown-Friday, J.</creatorcontrib><creatorcontrib>Xhori, E.</creatorcontrib><creatorcontrib>Ballentine-Cargill, K.</creatorcontrib><creatorcontrib>Duran, S.</creatorcontrib><creatorcontrib>Estrella, H.</creatorcontrib><creatorcontrib>Gonzalez de la torre, S.</creatorcontrib><creatorcontrib>Lukin, J.</creatorcontrib><creatorcontrib>Phillips, L.S.</creatorcontrib><creatorcontrib>Burgess, E.</creatorcontrib><creatorcontrib>Olson, D.</creatorcontrib><creatorcontrib>Rhee, M.</creatorcontrib><creatorcontrib>Wilson, P.</creatorcontrib><creatorcontrib>Raines, T.S.</creatorcontrib><creatorcontrib>Boers, J.</creatorcontrib><creatorcontrib>Costello, J.</creatorcontrib><creatorcontrib>Maher-Albertelli, M.</creatorcontrib><creatorcontrib>Mungara, R.</creatorcontrib><creatorcontrib>Savoye, L.</creatorcontrib><creatorcontrib>White, C.A.</creatorcontrib><creatorcontrib>Gullett, C.</creatorcontrib><creatorcontrib>Holloway, L.</creatorcontrib><creatorcontrib>Morehead, F.</creatorcontrib><creatorcontrib>Person, S.</creatorcontrib><creatorcontrib>Sibymon, M.</creatorcontrib><creatorcontrib>Tanukonda, S.</creatorcontrib><creatorcontrib>Adams, C.</creatorcontrib><creatorcontrib>Ross, A.</creatorcontrib><creatorcontrib>Balasubramanyam, A.</creatorcontrib><creatorcontrib>Gaba, R.</creatorcontrib><creatorcontrib>Gonzalez Hattery, E.</creatorcontrib><creatorcontrib>Ideozu, A.</creatorcontrib><creatorcontrib>Jimenez, J.</creatorcontrib><creatorcontrib>Montes, G.</creatorcontrib><creatorcontrib>Wright, C.</creatorcontrib><creatorcontrib>Hollander, P.</creatorcontrib><creatorcontrib>Roe, E.</creatorcontrib><creatorcontrib>Jackson, A.</creatorcontrib><creatorcontrib>Smiley, A.</creatorcontrib><creatorcontrib>Burt, P.</creatorcontrib><creatorcontrib>Estrada, L.</creatorcontrib><creatorcontrib>Chionh, K.</creatorcontrib><creatorcontrib>Ismail-Beigi, F.</creatorcontrib><creatorcontrib>Falck-Ytter, C.</creatorcontrib><creatorcontrib>Sayyed Kassem, L.</creatorcontrib><creatorcontrib>Sood, A.</creatorcontrib><creatorcontrib>Tiktin, M.</creatorcontrib><creatorcontrib>Kulow, T.</creatorcontrib><creatorcontrib>Newman, C.</creatorcontrib><creatorcontrib>Stancil, K.A.</creatorcontrib><creatorcontrib>Cramer, B.</creatorcontrib><creatorcontrib>Iacoboni, J.</creatorcontrib><creatorcontrib>Kononets, M.V.</creatorcontrib><creatorcontrib>Sanders, C.</creatorcontrib><creatorcontrib>Tucker, L.</creatorcontrib><creatorcontrib>Werner, A.</creatorcontrib><creatorcontrib>Maxwell, A.</creatorcontrib><creatorcontrib>McPhee, G.</creatorcontrib><creatorcontrib>Patel, C.</creatorcontrib><creatorcontrib>Colosimo, L.</creatorcontrib><creatorcontrib>Krol, A.</creatorcontrib><creatorcontrib>Goland, R.</creatorcontrib><creatorcontrib>Pring, J.</creatorcontrib><creatorcontrib>Alfano, L.</creatorcontrib><creatorcontrib>Kringas, P.</creatorcontrib><creatorcontrib>Hausheer, C.</creatorcontrib><creatorcontrib>Tejada, J.</creatorcontrib><creatorcontrib>Gumpel, K.</creatorcontrib><creatorcontrib>Kirpitch, A.</creatorcontrib><creatorcontrib>Schneier, H.</creatorcontrib><creatorcontrib>Green, J.B.</creatorcontrib><creatorcontrib>AbouAssi, H.</creatorcontrib><creatorcontrib>Chatterjee, R.</creatorcontrib><creatorcontrib>Feinglos, M.N.</creatorcontrib><creatorcontrib>English Jones, J.</creatorcontrib><creatorcontrib>Khan, S.A.</creatorcontrib><creatorcontrib>Kimpel, J.B.</creatorcontrib><creatorcontrib>Zimmer, R.P.</creatorcontrib><creatorcontrib>Furst, M.</creatorcontrib><creatorcontrib>Satterwhite, B.M.</creatorcontrib><creatorcontrib>Thacker, C.R.</creatorcontrib><creatorcontrib>Evans Kreider, K.</creatorcontrib><creatorcontrib>Mariash, C.N.</creatorcontrib><creatorcontrib>Mather, K.J.</creatorcontrib><creatorcontrib>Ismail, H.M.</creatorcontrib><creatorcontrib>Lteif, A.</creatorcontrib><creatorcontrib>Mullen, M.</creatorcontrib><creatorcontrib>GRADE Research Group</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Diabetes care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Aroda, Vanita R.</au><au>Krause-Steinrauf, Heidi</au><au>Kazemi, Erin J.</au><au>Buse, John B.</au><au>Gulanski, Barbara I.</au><au>Florez, Hermes J.</au><au>Ahmann, Andrew J.</au><au>Loveland, Amy</au><au>Kuhn, Alexander</au><au>Lonier, Jacqueline Y.</au><au>Wexler, Deborah J.</au><au>Crandall, J.P.</au><au>McKee, M.D.</au><au>Behringer-Massera, S.</au><au>Brown-Friday, J.</au><au>Xhori, E.</au><au>Ballentine-Cargill, K.</au><au>Duran, S.</au><au>Estrella, H.</au><au>Gonzalez de la torre, S.</au><au>Lukin, J.</au><au>Phillips, L.S.</au><au>Burgess, E.</au><au>Olson, D.</au><au>Rhee, M.</au><au>Wilson, P.</au><au>Raines, T.S.</au><au>Boers, J.</au><au>Costello, J.</au><au>Maher-Albertelli, M.</au><au>Mungara, R.</au><au>Savoye, L.</au><au>White, C.A.</au><au>Gullett, C.</au><au>Holloway, L.</au><au>Morehead, F.</au><au>Person, S.</au><au>Sibymon, M.</au><au>Tanukonda, S.</au><au>Adams, C.</au><au>Ross, A.</au><au>Balasubramanyam, A.</au><au>Gaba, R.</au><au>Gonzalez Hattery, E.</au><au>Ideozu, A.</au><au>Jimenez, J.</au><au>Montes, G.</au><au>Wright, C.</au><au>Hollander, P.</au><au>Roe, E.</au><au>Jackson, A.</au><au>Smiley, A.</au><au>Burt, P.</au><au>Estrada, L.</au><au>Chionh, K.</au><au>Ismail-Beigi, F.</au><au>Falck-Ytter, C.</au><au>Sayyed Kassem, L.</au><au>Sood, A.</au><au>Tiktin, M.</au><au>Kulow, T.</au><au>Newman, C.</au><au>Stancil, K.A.</au><au>Cramer, B.</au><au>Iacoboni, J.</au><au>Kononets, M.V.</au><au>Sanders, C.</au><au>Tucker, L.</au><au>Werner, A.</au><au>Maxwell, A.</au><au>McPhee, G.</au><au>Patel, C.</au><au>Colosimo, L.</au><au>Krol, A.</au><au>Goland, R.</au><au>Pring, J.</au><au>Alfano, L.</au><au>Kringas, P.</au><au>Hausheer, C.</au><au>Tejada, J.</au><au>Gumpel, K.</au><au>Kirpitch, A.</au><au>Schneier, H.</au><au>Green, J.B.</au><au>AbouAssi, H.</au><au>Chatterjee, R.</au><au>Feinglos, M.N.</au><au>English Jones, J.</au><au>Khan, S.A.</au><au>Kimpel, J.B.</au><au>Zimmer, R.P.</au><au>Furst, M.</au><au>Satterwhite, B.M.</au><au>Thacker, C.R.</au><au>Evans Kreider, K.</au><au>Mariash, C.N.</au><au>Mather, K.J.</au><au>Ismail, H.M.</au><au>Lteif, A.</au><au>Mullen, M.</au><aucorp>GRADE Research Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical and Metabolic Characterization of Adults With Type 2 Diabetes by Age in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) Cohort</atitle><jtitle>Diabetes care</jtitle><date>2022-07-01</date><risdate>2022</risdate><volume>45</volume><issue>7</issue><spage>1512</spage><epage>1521</epage><pages>1512-1521</pages><issn>0149-5992</issn><eissn>1935-5548</eissn><abstract>OBJECTIVE Differences in type 2 diabetes phenotype by age are described, but it is not known whether these differences are seen in a more uniformly defined adult population at a common early stage of care. We sought to characterize age-related clinical and metabolic characteristics of adults with type 2 diabetes on metformin monotherapy, prior to treatment intensification. RESEARCH DESIGN AND METHODS In the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE), participants were enrolled who had type 2 diabetes duration <10 years, had HbA1c 6.8–8.5%, and were on metformin monotherapy. Participants were randomly assigned to one of four additional glucose-lowering medications. We compared baseline clinical and metabolic characteristics across age categories (<45, 45 to <55, 55 to <65, and ≥65 years) using ANOVA and Pearson χ2 tests. RESULTS Within the GRADE cohort (n = 5,047), we observed significant differences by age, with younger adults having greater racial diversity, fewer medications for common comorbidities, lower prevalence of CVD, higher weight and BMI, and more pronounced hyperglycemia and diabetic dyslipidemia and with metabolic profile indicating lower insulin sensitivity (inverse fasting insulin [1/(fasting insulin)], HOMA of steady-state insulin sensitivity, Matsuda index) and inadequate β-cell response (oral disposition index) (P < 0.05 across age categories). CONCLUSIONS Clinical and metabolic characteristics of type 2 diabetes differ by age within the GRADE cohort. Younger adults exhibit more prominent obesity-related characteristics, including higher obesity levels and lower insulin sensitivity and β-cell compensation. Given the increasing burden of type 2 diabetes and complications, particularly among younger populations, these age-related distinctions may inform risk factor management approaches and treatment priorities. Further study will determine whether age-related differences impact response to therapy.</abstract><cop>Alexandria</cop><pub>American Diabetes Association</pub><doi>10.2337/dc21-2659</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-7706-4585</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0149-5992 |
| ispartof | Diabetes care, 2022-07, Vol.45 (7), p.1512-1521 |
| issn | 0149-5992 1935-5548 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9375440 |
| source | EZB-FREE-00999 freely available EZB journals |
| subjects | Adults Age Antidiabetics Beta cells Blood glucose Clinical Care/Education/Nutrition/Psychosocial Research Comorbidity Complications Diabetes Diabetes mellitus Diabetes mellitus (non-insulin dependent) Dyslipidemia Effectiveness studies Fasting Genotype & phenotype Hyperglycemia Impact response Insulin Laboratory testing Metabolism Metformin Obesity Phenotypes Race Reduction Risk analysis Risk factors Risk management Sensitivity Variance analysis |
| title | Clinical and Metabolic Characterization of Adults With Type 2 Diabetes by Age in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) Cohort |
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