Prevalence of microvascular and macrovascular disease in the Glycemia Reduction Approaches in Diabetes - A Comparative Effectiveness (GRADE) Study cohort

the GRADE Research Group

doi:10.1016/j.diabres.2020.108235

Prevalence of microvascular and macrovascular disease in the Glycemia Reduction Approaches in Diabetes - A Comparative Effectiveness (GRADE) Study cohort

the GRADE Research Group

Administration (TMED)

Research output: Contribution to journal › Article › peer-review

10 Scopus citations

Abstract

AIMS: The Glycemia Reduction Approaches in Diabetes - A Comparative Effectiveness (GRADE) trial is a randomized clinical trial comparing glycemic effects of four diabetes medications added to metformin in type 2 diabetes (T2D). Microvascular and macrovascular diseases are secondary outcomes. We evaluated the prevalence and risk factor relationships for microvascular and macrovascular complications in the GRADE cohort at study entry.

METHODS: Complication prevalence and risk factors were analyzed based on data from screening in all consenting participants meeting GRADE eligibility. Logistic regression and Z-statistics were used to assess risk factor relationships with complications.

RESULTS: We enrolled 5047 T2D participants [mean age 57 years; 36% female; mean known T2D duration 4 years (all < 10 years); mean HbA1c 8.0% (∼64 mmol/mol) at screening]. Urinary albumin/creatinine ratio (ACR) ≥ 30 mg/gram was present in 15.9% participants; peripheral neuropathy (by Michigan Neuropathy Screening Instrument) in 21.5%; cardiovascular autonomic neuropathy by electrocardiography-derived indices in 9.7%; self-reported retinopathy in 1.0%. Myocardial infarction ascertained by self-report or electrocardiogram was present in 7.3%, and self-reported history of stroke in 2.0%.

CONCLUSIONS: In the GRADE cohort with < 10 years of T2D and a mean HbA1c of 8.0%, diabetes complications were present in a substantial fraction of participants, more so than might otherwise have been expected.

Original language	English (US)
Article number	108235
Journal	Diabetes Research and Clinical Practice
Volume	165
DOIs	https://doi.org/10.1016/j.diabres.2020.108235
State	Published - Jul 2020

Bibliographical note

Funding Information:
The GRADE Study is supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health under Award Number U01DK098246. The planning of GRADE was supported by a U34 planning grant from the NIDDK (U34-DK-088043). The American Diabetes Association supported the initial planning meeting for the U34 proposal. The National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention also provided funding support. The Department of Veterans Affairs provided resources and facilities. Additional support was provided by grant numbers P30 DK017047, P30 DK020541-44, P30 DK020572, P30 DK072476, P30 DK079626, P30 DK092926, U54 GM104940, UL1 TR000439, UL1 TR000445, UL1 TR001108, UL1 TR001409, UL1 TR001449, UL1 TR002243, UL1 TR002345, UL1 TR002378, UL1 TR002489, UL1 TR002489, UL1 TR002529, UL1 TR002535, UL1 TR002537, and UL1 TR002548. Educational materials have been provided by the National Diabetes Education Program. Material support in the form of donated medications and supplies has been provided by BD, Bristol-Myers Squibb, Merck, NovoNordisk, Roche Diagnostics, and Sanofi. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. RMC reports grants from National Institutes of Health, during the conduct of the study; “other” conflicts from Bristol Myers Squibb, “other” conflicts from Pfizer, outside the submitted work. CD reports grants and personal fees from Novo Nordisk, personal fees from Astra Zeneca, grants from Sanofi, grants from the Department of Defense, outside the submitted work. JBG reports grants from NIDDK, during the conduct of the study; grants and personal fees from Boehringer Ingelheim, grants from Sanofi, grants from GlaxoSmithKline, grants from Intarcia Therapeutics, grants and personal fees from AstraZeneca, personal fees from Daiichi, personal fees from NovoNordisk, grants from Merck, personal fees from PriMedCME, personal fees from Horizon CME, personal fees from Potomac Center for Medical Education, personal fees from Guthrie Clinic, personal fees from University of Kentucky, personal fees from Bioscientifica, personals fees from The Endocrine Society, outside the submitted work. MSK reports grants from Novo Nordisk, grants from Theracos, grants from Bayer, outside the submitted work. ERS reports grants and personal fees from Eli Lilly, personal fees from Sanofi, personal fees from Zucara, personal fees from MannKind, outside the submitted work. DJW reports other from NovoNordisk, outside the submitted work. RPB reports grants from National Institute of Diabetes and Digestive and Kidney Diseases, NIH (U34 DK088043 and U01 DK098246, from National Heart, Lung, and Blood Institute, from Centers for Disease Control and Prevention, and from The American Diabetes Association during the conduct of the study; grants from Astra Zeneca, personal fees from Novo Nordisk, outside the submitted work. KJM, IB, CB, JPC, HKS, MEL, JP, EZS, and EBS have nothing to disclose. All authors affirm that authorship is merited based on the ICMJE authorship criteria. IB, JPC, CD, JBG, HKS, MEL, KJM, RP-B, EBS, and DJW contributed to the conception and design of this manuscript. IB, JPS, CD, JBG, HKS, KJM, JP, ERS, RP-B and EZS contributed to the acquisition of data for this manuscript. IB contributed to the statistical analysis of data for this manuscript. CB, IB, RMC, JPC, CD, JBG, MSK, HKS, KJM, RP-B, ERS, EBS, EZS, and DJW contributed to the interpretation of data and results for this manuscript. CD, KJM, RP-B, and ERS contributed to the supervision and management of research for this manuscript. IB, CD, HKS, HKS, MEL, KJM, and RP-B contributed to the drafting of this manuscript. CB, IB, RMC, JPC, CD, JBG, MSK, HKS, KJM, JP, RP-B, ERS, EBS, EZS, and DJS contributed to the critical review of this manuscript. IB, KJM and RP-B are guarantors of this work, and as such, had full access to all the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis.

Funding Information:
The GRADE Study is supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health under Award Number U01DK098246. The planning of GRADE was supported by a U34 planning grant from the NIDDK ( U34-DK-088043 ). The American Diabetes Association supported the initial planning meeting for the U34 proposal. The National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention also provided funding support. The Department of Veterans Affairs provided resources and facilities. Additional support was provided by grant numbers P30 DK017047, P30 DK020541-44, P30 DK020572, P30 DK072476, P30 DK079626, P30 DK092926, U54 GM104940, UL1 TR000439, UL1 TR000445, UL1 TR001108, UL1 TR001409, UL1 TR001449, UL1 TR002243, UL1 TR002345, UL1 TR002378, UL1 TR002489, UL1 TR002489, UL1 TR002529, UL1 TR002535, UL1 TR002537, and UL1 TR002548. Educational materials have been provided by the National Diabetes Education Program. Material support in the form of donated medications and supplies has been provided by BD, Bristol-Myers Squibb, Merck, NovoNordisk, Roche Diagnostics, and Sanofi. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© 2020 Elsevier B.V.

Keywords

Comparative effectiveness
Complications
Diabetes
Pragmatic
Prevalence
Treatment
Diabetes Complications/epidemiology
Humans
Middle Aged
Male
Diabetes Mellitus, Type 2/complications
Female
Cohort Studies

PubMed: MeSH publication types

Journal Article

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.diabres.2020.108235

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@article{99a2b52815864b10b299489003b80e22,

title = "Prevalence of microvascular and macrovascular disease in the Glycemia Reduction Approaches in Diabetes - A Comparative Effectiveness (GRADE) Study cohort",

abstract = "AIMS: The Glycemia Reduction Approaches in Diabetes - A Comparative Effectiveness (GRADE) trial is a randomized clinical trial comparing glycemic effects of four diabetes medications added to metformin in type 2 diabetes (T2D). Microvascular and macrovascular diseases are secondary outcomes. We evaluated the prevalence and risk factor relationships for microvascular and macrovascular complications in the GRADE cohort at study entry.METHODS: Complication prevalence and risk factors were analyzed based on data from screening in all consenting participants meeting GRADE eligibility. Logistic regression and Z-statistics were used to assess risk factor relationships with complications.RESULTS: We enrolled 5047 T2D participants [mean age 57 years; 36% female; mean known T2D duration 4 years (all < 10 years); mean HbA1c 8.0% (∼64 mmol/mol) at screening]. Urinary albumin/creatinine ratio (ACR) ≥ 30 mg/gram was present in 15.9% participants; peripheral neuropathy (by Michigan Neuropathy Screening Instrument) in 21.5%; cardiovascular autonomic neuropathy by electrocardiography-derived indices in 9.7%; self-reported retinopathy in 1.0%. Myocardial infarction ascertained by self-report or electrocardiogram was present in 7.3%, and self-reported history of stroke in 2.0%.CONCLUSIONS: In the GRADE cohort with < 10 years of T2D and a mean HbA1c of 8.0%, diabetes complications were present in a substantial fraction of participants, more so than might otherwise have been expected.",

keywords = "Comparative effectiveness, Complications, Diabetes, Pragmatic, Prevalence, Treatment, Diabetes Complications/epidemiology, Humans, Middle Aged, Male, Diabetes Mellitus, Type 2/complications, Female, Cohort Studies",

author = "{the GRADE Research Group} and Mather, {Kieren J.} and Ionut Bebu and Chelsea Baker and Cohen, {Robert M.} and Crandall, {Jill P.} and Cyrus DeSouza and Green, {Jennifer B.} and Kirkman, {M. Sue} and Heidi Krause-Steinrauf and Mary Larkin and Jeremy Pettus and Seaquist, {Elizabeth R.} and Soliman, {Elsayed Z.} and Schroeder, {Emily B.} and Wexler, {Deborah J.} and Rodica Pop-Busui",

note = "Funding Information: The GRADE Study is supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health under Award Number U01DK098246. The planning of GRADE was supported by a U34 planning grant from the NIDDK (U34-DK-088043). The American Diabetes Association supported the initial planning meeting for the U34 proposal. The National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention also provided funding support. The Department of Veterans Affairs provided resources and facilities. Additional support was provided by grant numbers P30 DK017047, P30 DK020541-44, P30 DK020572, P30 DK072476, P30 DK079626, P30 DK092926, U54 GM104940, UL1 TR000439, UL1 TR000445, UL1 TR001108, UL1 TR001409, UL1 TR001449, UL1 TR002243, UL1 TR002345, UL1 TR002378, UL1 TR002489, UL1 TR002489, UL1 TR002529, UL1 TR002535, UL1 TR002537, and UL1 TR002548. Educational materials have been provided by the National Diabetes Education Program. Material support in the form of donated medications and supplies has been provided by BD, Bristol-Myers Squibb, Merck, NovoNordisk, Roche Diagnostics, and Sanofi. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. RMC reports grants from National Institutes of Health, during the conduct of the study; “other” conflicts from Bristol Myers Squibb, “other” conflicts from Pfizer, outside the submitted work. CD reports grants and personal fees from Novo Nordisk, personal fees from Astra Zeneca, grants from Sanofi, grants from the Department of Defense, outside the submitted work. JBG reports grants from NIDDK, during the conduct of the study; grants and personal fees from Boehringer Ingelheim, grants from Sanofi, grants from GlaxoSmithKline, grants from Intarcia Therapeutics, grants and personal fees from AstraZeneca, personal fees from Daiichi, personal fees from NovoNordisk, grants from Merck, personal fees from PriMedCME, personal fees from Horizon CME, personal fees from Potomac Center for Medical Education, personal fees from Guthrie Clinic, personal fees from University of Kentucky, personal fees from Bioscientifica, personals fees from The Endocrine Society, outside the submitted work. MSK reports grants from Novo Nordisk, grants from Theracos, grants from Bayer, outside the submitted work. ERS reports grants and personal fees from Eli Lilly, personal fees from Sanofi, personal fees from Zucara, personal fees from MannKind, outside the submitted work. DJW reports other from NovoNordisk, outside the submitted work. RPB reports grants from National Institute of Diabetes and Digestive and Kidney Diseases, NIH (U34 DK088043 and U01 DK098246, from National Heart, Lung, and Blood Institute, from Centers for Disease Control and Prevention, and from The American Diabetes Association during the conduct of the study; grants from Astra Zeneca, personal fees from Novo Nordisk, outside the submitted work. KJM, IB, CB, JPC, HKS, MEL, JP, EZS, and EBS have nothing to disclose. All authors affirm that authorship is merited based on the ICMJE authorship criteria. IB, JPC, CD, JBG, HKS, MEL, KJM, RP-B, EBS, and DJW contributed to the conception and design of this manuscript. IB, JPS, CD, JBG, HKS, KJM, JP, ERS, RP-B and EZS contributed to the acquisition of data for this manuscript. IB contributed to the statistical analysis of data for this manuscript. CB, IB, RMC, JPC, CD, JBG, MSK, HKS, KJM, RP-B, ERS, EBS, EZS, and DJW contributed to the interpretation of data and results for this manuscript. CD, KJM, RP-B, and ERS contributed to the supervision and management of research for this manuscript. IB, CD, HKS, HKS, MEL, KJM, and RP-B contributed to the drafting of this manuscript. CB, IB, RMC, JPC, CD, JBG, MSK, HKS, KJM, JP, RP-B, ERS, EBS, EZS, and DJS contributed to the critical review of this manuscript. IB, KJM and RP-B are guarantors of this work, and as such, had full access to all the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis. Funding Information: The GRADE Study is supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health under Award Number U01DK098246. The planning of GRADE was supported by a U34 planning grant from the NIDDK ( U34-DK-088043 ). The American Diabetes Association supported the initial planning meeting for the U34 proposal. The National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention also provided funding support. The Department of Veterans Affairs provided resources and facilities. Additional support was provided by grant numbers P30 DK017047, P30 DK020541-44, P30 DK020572, P30 DK072476, P30 DK079626, P30 DK092926, U54 GM104940, UL1 TR000439, UL1 TR000445, UL1 TR001108, UL1 TR001409, UL1 TR001449, UL1 TR002243, UL1 TR002345, UL1 TR002378, UL1 TR002489, UL1 TR002489, UL1 TR002529, UL1 TR002535, UL1 TR002537, and UL1 TR002548. Educational materials have been provided by the National Diabetes Education Program. Material support in the form of donated medications and supplies has been provided by BD, Bristol-Myers Squibb, Merck, NovoNordisk, Roche Diagnostics, and Sanofi. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: {\textcopyright} 2020 Elsevier B.V.",

year = "2020",

month = jul,

doi = "10.1016/j.diabres.2020.108235",

language = "English (US)",

volume = "165",

journal = "Diabetes Research and Clinical Practice",

issn = "0168-8227",

publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Prevalence of microvascular and macrovascular disease in the Glycemia Reduction Approaches in Diabetes - A Comparative Effectiveness (GRADE) Study cohort

AU - the GRADE Research Group

AU - Mather, Kieren J.

AU - Bebu, Ionut

AU - Baker, Chelsea

AU - Cohen, Robert M.

AU - Crandall, Jill P.

AU - DeSouza, Cyrus

AU - Green, Jennifer B.

AU - Kirkman, M. Sue

AU - Krause-Steinrauf, Heidi

AU - Larkin, Mary

AU - Pettus, Jeremy

AU - Seaquist, Elizabeth R.

AU - Soliman, Elsayed Z.

AU - Schroeder, Emily B.

AU - Wexler, Deborah J.

AU - Pop-Busui, Rodica

N1 - Funding Information: The GRADE Study is supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health under Award Number U01DK098246. The planning of GRADE was supported by a U34 planning grant from the NIDDK (U34-DK-088043). The American Diabetes Association supported the initial planning meeting for the U34 proposal. The National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention also provided funding support. The Department of Veterans Affairs provided resources and facilities. Additional support was provided by grant numbers P30 DK017047, P30 DK020541-44, P30 DK020572, P30 DK072476, P30 DK079626, P30 DK092926, U54 GM104940, UL1 TR000439, UL1 TR000445, UL1 TR001108, UL1 TR001409, UL1 TR001449, UL1 TR002243, UL1 TR002345, UL1 TR002378, UL1 TR002489, UL1 TR002489, UL1 TR002529, UL1 TR002535, UL1 TR002537, and UL1 TR002548. Educational materials have been provided by the National Diabetes Education Program. Material support in the form of donated medications and supplies has been provided by BD, Bristol-Myers Squibb, Merck, NovoNordisk, Roche Diagnostics, and Sanofi. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. RMC reports grants from National Institutes of Health, during the conduct of the study; “other” conflicts from Bristol Myers Squibb, “other” conflicts from Pfizer, outside the submitted work. CD reports grants and personal fees from Novo Nordisk, personal fees from Astra Zeneca, grants from Sanofi, grants from the Department of Defense, outside the submitted work. JBG reports grants from NIDDK, during the conduct of the study; grants and personal fees from Boehringer Ingelheim, grants from Sanofi, grants from GlaxoSmithKline, grants from Intarcia Therapeutics, grants and personal fees from AstraZeneca, personal fees from Daiichi, personal fees from NovoNordisk, grants from Merck, personal fees from PriMedCME, personal fees from Horizon CME, personal fees from Potomac Center for Medical Education, personal fees from Guthrie Clinic, personal fees from University of Kentucky, personal fees from Bioscientifica, personals fees from The Endocrine Society, outside the submitted work. MSK reports grants from Novo Nordisk, grants from Theracos, grants from Bayer, outside the submitted work. ERS reports grants and personal fees from Eli Lilly, personal fees from Sanofi, personal fees from Zucara, personal fees from MannKind, outside the submitted work. DJW reports other from NovoNordisk, outside the submitted work. RPB reports grants from National Institute of Diabetes and Digestive and Kidney Diseases, NIH (U34 DK088043 and U01 DK098246, from National Heart, Lung, and Blood Institute, from Centers for Disease Control and Prevention, and from The American Diabetes Association during the conduct of the study; grants from Astra Zeneca, personal fees from Novo Nordisk, outside the submitted work. KJM, IB, CB, JPC, HKS, MEL, JP, EZS, and EBS have nothing to disclose. All authors affirm that authorship is merited based on the ICMJE authorship criteria. IB, JPC, CD, JBG, HKS, MEL, KJM, RP-B, EBS, and DJW contributed to the conception and design of this manuscript. IB, JPS, CD, JBG, HKS, KJM, JP, ERS, RP-B and EZS contributed to the acquisition of data for this manuscript. IB contributed to the statistical analysis of data for this manuscript. CB, IB, RMC, JPC, CD, JBG, MSK, HKS, KJM, RP-B, ERS, EBS, EZS, and DJW contributed to the interpretation of data and results for this manuscript. CD, KJM, RP-B, and ERS contributed to the supervision and management of research for this manuscript. IB, CD, HKS, HKS, MEL, KJM, and RP-B contributed to the drafting of this manuscript. CB, IB, RMC, JPC, CD, JBG, MSK, HKS, KJM, JP, RP-B, ERS, EBS, EZS, and DJS contributed to the critical review of this manuscript. IB, KJM and RP-B are guarantors of this work, and as such, had full access to all the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis. Funding Information: The GRADE Study is supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health under Award Number U01DK098246. The planning of GRADE was supported by a U34 planning grant from the NIDDK ( U34-DK-088043 ). The American Diabetes Association supported the initial planning meeting for the U34 proposal. The National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention also provided funding support. The Department of Veterans Affairs provided resources and facilities. Additional support was provided by grant numbers P30 DK017047, P30 DK020541-44, P30 DK020572, P30 DK072476, P30 DK079626, P30 DK092926, U54 GM104940, UL1 TR000439, UL1 TR000445, UL1 TR001108, UL1 TR001409, UL1 TR001449, UL1 TR002243, UL1 TR002345, UL1 TR002378, UL1 TR002489, UL1 TR002489, UL1 TR002529, UL1 TR002535, UL1 TR002537, and UL1 TR002548. Educational materials have been provided by the National Diabetes Education Program. Material support in the form of donated medications and supplies has been provided by BD, Bristol-Myers Squibb, Merck, NovoNordisk, Roche Diagnostics, and Sanofi. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: © 2020 Elsevier B.V.

PY - 2020/7

Y1 - 2020/7

N2 - AIMS: The Glycemia Reduction Approaches in Diabetes - A Comparative Effectiveness (GRADE) trial is a randomized clinical trial comparing glycemic effects of four diabetes medications added to metformin in type 2 diabetes (T2D). Microvascular and macrovascular diseases are secondary outcomes. We evaluated the prevalence and risk factor relationships for microvascular and macrovascular complications in the GRADE cohort at study entry.METHODS: Complication prevalence and risk factors were analyzed based on data from screening in all consenting participants meeting GRADE eligibility. Logistic regression and Z-statistics were used to assess risk factor relationships with complications.RESULTS: We enrolled 5047 T2D participants [mean age 57 years; 36% female; mean known T2D duration 4 years (all < 10 years); mean HbA1c 8.0% (∼64 mmol/mol) at screening]. Urinary albumin/creatinine ratio (ACR) ≥ 30 mg/gram was present in 15.9% participants; peripheral neuropathy (by Michigan Neuropathy Screening Instrument) in 21.5%; cardiovascular autonomic neuropathy by electrocardiography-derived indices in 9.7%; self-reported retinopathy in 1.0%. Myocardial infarction ascertained by self-report or electrocardiogram was present in 7.3%, and self-reported history of stroke in 2.0%.CONCLUSIONS: In the GRADE cohort with < 10 years of T2D and a mean HbA1c of 8.0%, diabetes complications were present in a substantial fraction of participants, more so than might otherwise have been expected.

AB - AIMS: The Glycemia Reduction Approaches in Diabetes - A Comparative Effectiveness (GRADE) trial is a randomized clinical trial comparing glycemic effects of four diabetes medications added to metformin in type 2 diabetes (T2D). Microvascular and macrovascular diseases are secondary outcomes. We evaluated the prevalence and risk factor relationships for microvascular and macrovascular complications in the GRADE cohort at study entry.METHODS: Complication prevalence and risk factors were analyzed based on data from screening in all consenting participants meeting GRADE eligibility. Logistic regression and Z-statistics were used to assess risk factor relationships with complications.RESULTS: We enrolled 5047 T2D participants [mean age 57 years; 36% female; mean known T2D duration 4 years (all < 10 years); mean HbA1c 8.0% (∼64 mmol/mol) at screening]. Urinary albumin/creatinine ratio (ACR) ≥ 30 mg/gram was present in 15.9% participants; peripheral neuropathy (by Michigan Neuropathy Screening Instrument) in 21.5%; cardiovascular autonomic neuropathy by electrocardiography-derived indices in 9.7%; self-reported retinopathy in 1.0%. Myocardial infarction ascertained by self-report or electrocardiogram was present in 7.3%, and self-reported history of stroke in 2.0%.CONCLUSIONS: In the GRADE cohort with < 10 years of T2D and a mean HbA1c of 8.0%, diabetes complications were present in a substantial fraction of participants, more so than might otherwise have been expected.

KW - Comparative effectiveness

KW - Complications

KW - Diabetes

KW - Pragmatic

KW - Prevalence

KW - Treatment

KW - Diabetes Complications/epidemiology

KW - Humans

KW - Middle Aged

KW - Male

KW - Diabetes Mellitus, Type 2/complications

KW - Female

KW - Cohort Studies

UR - http://www.scopus.com/inward/record.url?scp=85087697759&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85087697759&partnerID=8YFLogxK

U2 - 10.1016/j.diabres.2020.108235

DO - 10.1016/j.diabres.2020.108235

M3 - Article

C2 - 32450102

AN - SCOPUS:85087697759

SN - 0168-8227

VL - 165

JO - Diabetes Research and Clinical Practice

JF - Diabetes Research and Clinical Practice

M1 - 108235

ER -

Prevalence of microvascular and macrovascular disease in the Glycemia Reduction Approaches in Diabetes - A Comparative Effectiveness (GRADE) Study cohort

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

UN SDGs

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