Differential Effects of Type 2 Diabetes Treatment Regimens on Diabetes Distress and Depressive Symptoms in GRADE: A Randomized Clinical Trial

Le résumé fourni par la source

Objective: We evaluated whether adding basal insulin to metformin in adults with early type 2 diabetes mellitus (T2DM) would increase emotional distress relative to other treatments. Research Design and Methods: The Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE) study of adults with T2DM of < 10 years duration, HbA1c of 6.8-8.5%, and taking metformin monotherapy randomly assigned participants to add insulin glargine U-100, sulfonylurea glimepiride, glucagon-like peptide-1 receptor agonist liraglutide, or dipeptidyl peptidase 4 inhibitor sitagliptin. The Emotional Distress Substudy enrolled 1,739 GRADE participants (mean[SD] age, 58.0[10.2] years; 32% female; 56% non-Hispanic White, 18% non-Hispanic Black, 17% Hispanic) and assessed diabetes distress and depressive symptoms every six months. Analyses examined differences at one year and over the 3-year follow-up. Results: Across treatments, diabetes distress (-0.24, p<0.0001) and depressive symptoms (-0.67, p<0.0001) decreased over one year. Diabetes distress was lower at one year for glargine compared to the other groups combined (-0.10, p=0.002). Diabetes distress was also lower for liraglutide compared to glimepiride or sitagliptin (-0.10, p=0.008). Over the 3-year follow-up, there were no significant group differences in total diabetes distress; interpersonal diabetes distress remained lower for those assigned to liraglutide. No significant differences were observed for depressive symptoms. Conclusions: Contrary to expectations, this randomized trial found no evidence for a deleterious effect of basal insulin on emotional distress; glargine lowered diabetes distress modestly at one year rather than increasing it. Liraglutide also reduced diabetes distress at one year. Results can inform treatment decisions for adults with early T2DM.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.