Glucose Control and Weight Change Associated with Treatment with Exenatide Compared with Basal Insulin: A Retrospective Study

Abstract

IntroductionThe aim of the study was to compare glycemic and weight change outcomes for type 2 diabetes patients treated with either exenatide once-weekly (EQW) or exenatide twice-daily (EBID) with those patients treated with basal insulin (BI).MethodsRetrospective data (2010–2014) were extracted from the Clinical Practice Research Datalink, a UK primary care database. Patients previously naïve to injectable therapy initiating EQW, EBID, or BI were extracted and matched by propensity score within two analyses (EQW vs BI and EBID vs BI). Absolute and relative change in HbA1c and weight from baseline and the proportion of patients achieving HbA1c ≤ 7.0% (53 mmol/mol) combined with weight reduction targets of (1) any weight loss or (2) ≥ 5.0% from baseline were compared at 6 and 12–24 months.ResultsA total of 485 patients initiated EQW, 3573 EBID, and 13,503 BI. In the propensity matched EQW versus BI analysis, mean HbA1c decreased with changes of − 1.33% (− 14.5 mmol/mol) and − 1.24% (− 13.5 mmol/mol) at 6 months and − 1.19% (− 13.0 mmol/mol) and − 1.17% (− 12.8 mmol/mol) at 12–24 months, respectively. Respective weight change was − 3.7 kg versus + 1.2 kg (p < 0.001) and − 3.2 kg versus + 2.5 kg (p < 0.001). Significantly more EQW patients achieved the combined HbA1c ≤ 7.0% (53 mmol/mol) and weight loss target (22.4% versus 9.9% at 6 months and 18.2% versus 8.0% at 12–24 months, respectively) and HbA1c ≤ 7.0% (53 mmol/mol) and minimum 5% weight loss (11.8% versus 3.7% at 6 months, and 8.0% versus 0.0% at 12–24 months). For EBID versus BI, similar results were found.ConclusionIn this real-world data analysis, exenatide QW and exenatide BID were associated with similar glycemic control and greater weight reduction compared with basal insulin.

Glucagon-Like Peptide 1 Receptor Agonist (GLP1RA) Exposure and Outcomes in Type 2 Diabetes: A Systematic Review of Population-Based Observational Studies

“…We found 22 studies in total of which 12 were commercially funded [13][14][15][16][17][18][19][20][21][22][23][24][25] and 10 were funded by academic/non-profit/government organisations [26][27][28][29][30][31][32][33][34][35]. Six studies were identified through reference searching.…”

“…CIs were narrow for the white ethnicity but wide for the other ethnic groups. For background characteristics, see Table S14 9.3 A medium-sized British 2018 cohort study explored the association with severe hypoglycaemia in those previously naïve to any exenatide therapy vs. basal insulin ± OAD [ 20 ]. No association for exenatide on severe hypoglycaemia was observed, although the absolute rates of hypoglycaemia were higher in the insulin-exposed group compared to exenatide (DNS).…”

“…We found three studies exploring rates of severe hypoglycaemia, two investigating exenatide exposure (Tables 9.2 [ 31 ] and S13.1, and 9.3 [ 20 ]) and one the GLP1RA class overall (Tables 9.1 [ 24 ] and S13.2). All studies used an insulin comparator group (as opposed to OAD) and showed no association with hypoglycaemia risk [ 20 , 24 , 31 ].…”

“…Three studies explored this outcome [ 20 , 24 , 31 ]. For the GLP1RA class and for exenatide, the studies showed no association of exposure with hypoglycaemia (compared to insulin).…”

Comparison of Blood Glucose Variability Between Exenatide and Biphasic Insulin Aspart 30 in Chinese Participants with Type 2 Diabetes Inadequately Controlled with Metformin Monotherapy: A Multicenter, Open-Label, Randomized Trial

“…Exenatide belongs to the glucagon-like peptide-1 receptor agonist (GLP-1RA) class of medications [8], which enhances glucose-dependent insulin secretion, suppresses abnormally increased postprandial glucagon secretion, reduces food intake, and slows down gastric emptying [9,10]. Exenatide can reduce glycated hemoglobin (HbA1c) as well as postprandial blood glucose, while effectively reducing body weight in patients with T2DM [8,[11][12][13][14][15]. Unlike insulin, exenatide dosing does not need to be titrated to blood glucose levels.…”