Diabetes Care

Does hospitalization risk vary by glucose-lowering drug in T2DM?

June 9, 2025

Study details: The phase 3 Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) was a large, pragmatic, randomized trial comparing the effects of four glucose-lowering medications—insulin glargine, glimepiride, liraglutide, and sitagliptin—added to metformin in adults with T2DM. This secondary analysis focused on all-cause and cause-specific hospitalizations over a median follow-up of 5 years. Intention-to-treat (ITT) (N = 5,047) and on-assigned-treatment (AT) (N = 4,830) data sets were used.

Results: In the ITT analysis, time to first hospitalization didn’t differ significantly across groups (P = 0.148). However, in the AT analysis, liraglutide was associated with a 22% lower hazard of first hospitalization compared with glimepiride (HR 0.78; 95% confidence interval, 0.66–0.92; P = 0.022). Risk factors for subsequent hospitalizations included confirmed HbA1c >7.5% (29% increase), prior hospitalizations (41% increase per event), and treatment changes (56% increase). Notably, initial assignment to liraglutide reduced the risk of future hospitalizations by 13% compared with glimepiride.

Clinical impact: Choice of second-line glucose-lowering therapy can influence hospitalization risk in T2DM. Liraglutide may offer added benefit in reducing hospitalizations, supporting its consideration in patients at higher risk for complications.

Source:

Hsia DS, et al; GRADE Research Group. (2025, May 27). Diabetes Care. Association of Hospitalizations With Randomized Glycemia-Lowering Treatment in GRADE. https://pubmed.ncbi.nlm.nih.gov/40424051/