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Published in: Diabetology & Metabolic Syndrome 1/2016

Open Access 01-12-2016 | Research

LEADER 7: cardiovascular risk profiles of US and European participants in the LEADER diabetes trial differ

Authors: Guy E. H. M. Rutten, Cees J. Tack, Thomas R. Pieber, Abdurrahman Comlekci, David Dynnes Ørsted, Florian M. M. Baeres, Steven P. Marso, John B. Buse, on behalf of the LEADER Investigators

Published in: Diabetology & Metabolic Syndrome | Issue 1/2016

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Abstract

Aims

To determine whether US and European participants in the Liraglutide Effect and Action in Diabetes: Evaluation of cardiovascular outcome Results (LEADER) trial differ regarding risk factors for cardiovascular mortality and morbidity.

Methods

Baseline data, stratified for prior cardiovascular disease (CVD), were compared using multivariable logistic regression analysis to establish whether region is an independent determinant of achieved targets for glycated hemoglobin (HbA1c), blood pressure (BP), and low-density lipoprotein (LDL)-cholesterol.

Results

Independent of CVD history, US participants were more often of non-White origin and had a longer history of type 2 diabetes, higher body weight, and higher baseline HbA1c. They had substantially lower systolic and diastolic BP, and a marginally lower LDL-cholesterol level. Fewer US participants were diagnosed with left ventricular dysfunction. In the largest group of patients, those with prior CVD and the highest cardiovascular risk, US participants were more often female, had a higher waist circumference, and had a decreased estimated glomerular filtration rate, but less frequently prior myocardial infarction or angina pectoris.

Conclusions

There were baseline differences between US and European participants. These differences may result from variation in regional targets for cardiovascular risk factor management, and should be considered in the analysis and reporting of the trial results.
Clinical trial identifier: ClinicalTrials.gov, NCT01179048
Literature
1.
go back to reference Marso SP, Poulter NR, Nissen SE, Nauck MA, Zinman B, Daniels GH, Pocock S, Steinberg WM, Bergenstal RM, Mann JF, Ravn LS, Frandsen KB, Moses AC, Buse JB. Design of the liraglutide effect and action in diabetes: evaluation of cardiovascular outcome results (LEADER) trial. Am Heart J. 2013;166:823–30.CrossRefPubMed Marso SP, Poulter NR, Nissen SE, Nauck MA, Zinman B, Daniels GH, Pocock S, Steinberg WM, Bergenstal RM, Mann JF, Ravn LS, Frandsen KB, Moses AC, Buse JB. Design of the liraglutide effect and action in diabetes: evaluation of cardiovascular outcome results (LEADER) trial. Am Heart J. 2013;166:823–30.CrossRefPubMed
2.
go back to reference Holman RR, Sourij H, Califf RM. Cardiovascular outcome trials of glucose-lowering drugs or strategies in type 2 diabetes. Lancet. 2014;383:2008–17.CrossRefPubMed Holman RR, Sourij H, Califf RM. Cardiovascular outcome trials of glucose-lowering drugs or strategies in type 2 diabetes. Lancet. 2014;383:2008–17.CrossRefPubMed
3.
go back to reference Saunders C, Byrne CD, Guthrie B, Lindsay RS, McKnight JA, Philip S, Sattar N, Walker JJ, Wild SH, Scottish Diabetes Research Network Epidemiology Group. External validity of randomized controlled trials of glycaemic control and vascular disease: how representative are participants? Diabet Med. 2013;30:300–8.CrossRefPubMed Saunders C, Byrne CD, Guthrie B, Lindsay RS, McKnight JA, Philip S, Sattar N, Walker JJ, Wild SH, Scottish Diabetes Research Network Epidemiology Group. External validity of randomized controlled trials of glycaemic control and vascular disease: how representative are participants? Diabet Med. 2013;30:300–8.CrossRefPubMed
4.
go back to reference Rivers D, August EM, Sehovic I, Lee Green B, Quin GP. A systematic review of the factors influencing African American’s participation in cancer clinical trials. Contem Clin Trials. 2013;35:13–32.CrossRef Rivers D, August EM, Sehovic I, Lee Green B, Quin GP. A systematic review of the factors influencing African American’s participation in cancer clinical trials. Contem Clin Trials. 2013;35:13–32.CrossRef
5.
go back to reference Weiss CO, Boyd CM, Wolff JL, Leff B. Prevalence of diabetes treatment effect modifiers: the external validity of trials of older adults. Aging Clin Exp Res. 2012;24:370–6.CrossRefPubMedPubMedCentral Weiss CO, Boyd CM, Wolff JL, Leff B. Prevalence of diabetes treatment effect modifiers: the external validity of trials of older adults. Aging Clin Exp Res. 2012;24:370–6.CrossRefPubMedPubMedCentral
6.
go back to reference Kandzari DE, Roe MT, Chen AY, Lytle BL, Pollack CV Jr, Harrington RA, Ohman EM, Gibler WB, Peterson ED. Influence of clinical trial enrollment on the quality of care and outcomes for patients with non-ST-segment elevation acute coronary syndromes. Am Heart J. 2005;149:474–81.CrossRefPubMed Kandzari DE, Roe MT, Chen AY, Lytle BL, Pollack CV Jr, Harrington RA, Ohman EM, Gibler WB, Peterson ED. Influence of clinical trial enrollment on the quality of care and outcomes for patients with non-ST-segment elevation acute coronary syndromes. Am Heart J. 2005;149:474–81.CrossRefPubMed
7.
go back to reference Assmann SF, Pocock SJ, Enos LE, Kasten LE. Subgroup analysis and other (mis)uses of baseline data in clinical trials. Lancet. 2000;355:1064–9.CrossRefPubMed Assmann SF, Pocock SJ, Enos LE, Kasten LE. Subgroup analysis and other (mis)uses of baseline data in clinical trials. Lancet. 2000;355:1064–9.CrossRefPubMed
8.
go back to reference Gheorghe A, Roberts TE, Ives JC, Fletcher BR, Calvert M. Centre selection for clinical trials and the generalisability of results; a mixed methods study. PLoS One. 2013;8:e56560.CrossRefPubMedPubMedCentral Gheorghe A, Roberts TE, Ives JC, Fletcher BR, Calvert M. Centre selection for clinical trials and the generalisability of results; a mixed methods study. PLoS One. 2013;8:e56560.CrossRefPubMedPubMedCentral
9.
go back to reference Stone MA, Wilkinson JC, Charpentier G, Clochard N, Grassi G, Lindblad U, Müller UA, Nolan J, Rutten GE, Khunti K, GUIDANCE Study Group. Evaluation and comparison of guidelines for the management of people with type 2 diabetes from eight European countries. Diab Res Clin Pract. 2010;87:252–60.CrossRef Stone MA, Wilkinson JC, Charpentier G, Clochard N, Grassi G, Lindblad U, Müller UA, Nolan J, Rutten GE, Khunti K, GUIDANCE Study Group. Evaluation and comparison of guidelines for the management of people with type 2 diabetes from eight European countries. Diab Res Clin Pract. 2010;87:252–60.CrossRef
10.
go back to reference American Diabetes Association. Standards of Medical Care in Diabetes—2010. Diabetes Care. 2010;33:S4–10.CrossRef American Diabetes Association. Standards of Medical Care in Diabetes—2010. Diabetes Care. 2010;33:S4–10.CrossRef
11.
go back to reference Kent DM, Rothwell PM, Ioannidis JPA, Altman DG, Hayward RA. Assessing and reporting heterogeneity in treatment affects in clinical trials; a proposal. Trials. 2011;11:85.CrossRef Kent DM, Rothwell PM, Ioannidis JPA, Altman DG, Hayward RA. Assessing and reporting heterogeneity in treatment affects in clinical trials; a proposal. Trials. 2011;11:85.CrossRef
12.
go back to reference Wagner M, Balk EM, Kent DM, Kasiske BL, Ekberg H. Subgroup analyses in randomized controlled trials: the need for risk stratification in kidney transplantation. Am J Transplant. 2009;9:2217–22.CrossRefPubMedPubMedCentral Wagner M, Balk EM, Kent DM, Kasiske BL, Ekberg H. Subgroup analyses in randomized controlled trials: the need for risk stratification in kidney transplantation. Am J Transplant. 2009;9:2217–22.CrossRefPubMedPubMedCentral
13.
go back to reference Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL, Tsapas A, Wender R, Matthews DR, American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD). Management of hyperglycemia in type 2 diabetes: a patient-centered approach. Diabetes Care. 2012;35:1364–79.CrossRefPubMedPubMedCentral Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL, Tsapas A, Wender R, Matthews DR, American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD). Management of hyperglycemia in type 2 diabetes: a patient-centered approach. Diabetes Care. 2012;35:1364–79.CrossRefPubMedPubMedCentral
14.
go back to reference American Diabetes Association. Clinical Practice Recommendation. Diabetes Care. 2014;37:S1.CrossRef American Diabetes Association. Clinical Practice Recommendation. Diabetes Care. 2014;37:S1.CrossRef
15.
go back to reference Dorresteijn JA, Visseren FL, Ridker PM, Wassink AM, Paynter NP, Steyerberg EW, van der Graaf Y, Cook NR. Estimating treatment effects for individual patients based on the results of randomised clinical trials. BMJ. 2011;343:d5888.CrossRefPubMedPubMedCentral Dorresteijn JA, Visseren FL, Ridker PM, Wassink AM, Paynter NP, Steyerberg EW, van der Graaf Y, Cook NR. Estimating treatment effects for individual patients based on the results of randomised clinical trials. BMJ. 2011;343:d5888.CrossRefPubMedPubMedCentral
16.
go back to reference van der Leeuw J, Visseren FL, Woodward M, Zoungas S, Kengne AP, van der Graaf Y, Glasziou P, Hamet P, MacMahon S, Poulter N, Grobbee DE, Chalmers J. Predicting the effect of blood pressure lowering treatment on major cardiovascular events for individual patients with type 2 diabetes mellitus: results from Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation. Hypertension. 2015;65:115–21.CrossRefPubMed van der Leeuw J, Visseren FL, Woodward M, Zoungas S, Kengne AP, van der Graaf Y, Glasziou P, Hamet P, MacMahon S, Poulter N, Grobbee DE, Chalmers J. Predicting the effect of blood pressure lowering treatment on major cardiovascular events for individual patients with type 2 diabetes mellitus: results from Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation. Hypertension. 2015;65:115–21.CrossRefPubMed
17.
go back to reference Sardar P, Udell JA, Chatterjee S, Bansilal S, Mukherjee D, Farkouh ME. Effect of intensive versus standard blood glucose control in patients with type 2 diabetes in different regions of the world: systematic review and meta-analysis of randomized controlled trials. J Am Heart Assoc. 2015;4:e001577.CrossRefPubMedPubMedCentral Sardar P, Udell JA, Chatterjee S, Bansilal S, Mukherjee D, Farkouh ME. Effect of intensive versus standard blood glucose control in patients with type 2 diabetes in different regions of the world: systematic review and meta-analysis of randomized controlled trials. J Am Heart Assoc. 2015;4:e001577.CrossRefPubMedPubMedCentral
18.
go back to reference Bethel MA, Green JB, Milton J, Tajar A, Engel SS, Califf RM. Holman RR; TECOS Executive Committee. Regional, age and sex differences in baseline characteristics of patients enrolled in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS). Diabetes Obes Metab. 2015;17:395–402.CrossRefPubMed Bethel MA, Green JB, Milton J, Tajar A, Engel SS, Califf RM. Holman RR; TECOS Executive Committee. Regional, age and sex differences in baseline characteristics of patients enrolled in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS). Diabetes Obes Metab. 2015;17:395–402.CrossRefPubMed
19.
go back to reference Hardin DS, Rohwer RD, Curtis BH, Zagar A, Chen L, Boye KS, Jiang HH, Lipkovich IA. Understanding heterogeneity in response to antidiabetes treatment: a post hoc analysis using SIDES, a subgroup identification algorithm. J Diabetes Sci Technol. 2013;7:42.CrossRef Hardin DS, Rohwer RD, Curtis BH, Zagar A, Chen L, Boye KS, Jiang HH, Lipkovich IA. Understanding heterogeneity in response to antidiabetes treatment: a post hoc analysis using SIDES, a subgroup identification algorithm. J Diabetes Sci Technol. 2013;7:42.CrossRef
Metadata
Title
LEADER 7: cardiovascular risk profiles of US and European participants in the LEADER diabetes trial differ
Authors
Guy E. H. M. Rutten
Cees J. Tack
Thomas R. Pieber
Abdurrahman Comlekci
David Dynnes Ørsted
Florian M. M. Baeres
Steven P. Marso
John B. Buse
on behalf of the LEADER Investigators
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Diabetology & Metabolic Syndrome / Issue 1/2016
Electronic ISSN: 1758-5996
DOI
https://doi.org/10.1186/s13098-016-0153-5

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