Treatment of patients with type 2 diabetes with exenatide once weekly versus oral glucose-lowering medications or insulin glargine: achievement of glycemic and cardiovascular goals.

Publisher: BioMed Central Country of Publication: England NLM ID: 101147637 Publication Model: Electronic Cited Medium: Internet ISSN: 1475-2840 (Electronic) Linking ISSN: 14752840 NLM ISO Abbreviation: Cardiovasc Diabetol Subsets: MEDLINE

Original Publication: London : BioMed Central, [2002-

Blood Glucose/*drug effects ; Cardiovascular Diseases/*prevention & control ; Diabetes Mellitus, Type 2/*drug therapy ; Hypoglycemic Agents/*administration & dosage ; Insulin, Long-Acting/*administration & dosage ; Peptides/*administration & dosage ; Venoms/*administration & dosage; Administration, Oral ; Adult ; Aged ; Blood Glucose/metabolism ; Cardiovascular Diseases/blood ; Cardiovascular Diseases/epidemiology ; Diabetes Mellitus, Type 2/blood ; Diabetes Mellitus, Type 2/epidemiology ; Double-Blind Method ; Drug Administration Schedule ; Exenatide ; Female ; Glycemic Index/drug effects ; Glycemic Index/physiology ; Humans ; Insulin Glargine ; Male ; Middle Aged ; Patient Care Planning/trends ; Retrospective Studies ; Treatment Outcome

Background: Diabetes is associated with a higher risk for adverse cardiovascular outcomes. To improve the health outcomes of patients with type 2 diabetes (T2DM), the American Diabetes Association (ADA) recommended target goals for the improvement of glycemic control and the reduction of cardiovascular risk factors associated with the disease. This retrospective analysis calculated the absolute benefit increase (ABI) of using exenatide once weekly (QW), a glucagon-like peptide-1 (GLP-1) receptor agonist, vs an oral glucose-lowering medication or insulin glargine to achieve ADA-recommended goals. The number needed to treat (NNT) to achieve these goals was also calculated and provides a useful clinical metric for comparing potential therapies from different drug classes.
Methods: Patient data from three double-blind or open label, 26-week, randomized, controlled trials were retrospectively analyzed separately. ABI and NNT were calculated by comparing the percentage of patients treated with exenatide QW (N = 641) vs metformin (N = 246), sitagliptin (N = 329), pioglitazone (N = 328), or insulin glargine (N = 223), who achieved a single glycemic, weight, blood pressure, or lipid goal or a composite of these recommended goals, during the DURATION-2, -3, and -4 clinical trials.
Results: Significant ABIs favoring exenatide QW over all four glucose-lowering medications were observed for at least one HbA1c glycemic goal. NNTs of 4 and 5 were calculated when exenatide QW was compared to sitagliptin for attaining HbA1c goals of <7.0% and ≤6.5%, respectively. Additionally, significantly more patients using exenatide QW compared to sitagliptin, pioglitazone, or insulin glargine attained the composite goal of HbA1c <7% or ≤6.5%, without weight gain or hypoglycemia. Exenatide QW was also favored over sitagliptin and insulin glargine for the achievement of the composite goals of HbA1c <7% (or ≤6.5%), systolic blood pressure <130 mm Hg, and low-density lipoprotein <2.59 mmol/L. For most goals, exenatide QW and metformin had similar effects in treatment naïve patients.
Conclusions: This analysis assessed the between-therapy differences in achieving therapeutic goals with therapies commonly used for glycemic control in patients with T2DM. In clinical trials, exenatide QW assisted more patients in reaching the majority of ADA-recommended therapeutic goals than treatment with sitagliptin, pioglitazone, or insulin glargine.
Trial Registration: NCT00637273, NCT00641056, NCT00676338.

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ClinicalTrials.gov NCT00637273; NCT00641056; NCT00676338

0 (Blood Glucose)
0 (Hypoglycemic Agents)
0 (Insulin, Long-Acting)
0 (Peptides)
0 (Venoms)
2ZM8CX04RZ (Insulin Glargine)
9P1872D4OL (Exenatide)

Date Created: 20130326 Date Completed: 20131017 Latest Revision: 20211021

20240104

PMC3622579

10.1186/1475-2840-12-48

23522121